Healthcare Provider Details

I. General information

NPI: 1578449534
Provider Name (Legal Business Name): ENYA OHLENSCHLAGER VAN COLLER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTHPARK BLVD STE 201
ST AUGUSTINE FL
32086-3129
US

IV. Provider business mailing address

571 BAY LAUREL DR APT 53024
ST AUGUSTINE FL
32084-0213
US

V. Phone/Fax

Practice location:
  • Phone: 904-417-6236
  • Fax:
Mailing address:
  • Phone: 651-302-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT14027
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: