Healthcare Provider Details

I. General information

NPI: 1861314361
Provider Name (Legal Business Name): JEWEL TALIA MURRAY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
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

130 SHIPYARD WAY UNIT 2323
SAINT AUGUSTINE FL
32084-4269
US

V. Phone/Fax

Practice location:
  • Phone: 904-417-6236
  • Fax:
Mailing address:
  • Phone: 754-246-5734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT44379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: