Healthcare Provider Details

I. General information

NPI: 1366868432
Provider Name (Legal Business Name): UNIFY HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 WHISPERING PINES RD
SAINT JOHNS FL
32259-9186
US

IV. Provider business mailing address

450-106 STATE RD 13 #147
ST JOHNS FL
32259
US

V. Phone/Fax

Practice location:
  • Phone: 904-635-4638
  • Fax:
Mailing address:
  • Phone: 904-635-4638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLY INGRAM-MITCHELL
Title or Position: PRESIDENT
Credential: MPT
Phone: 904-635-4638