Healthcare Provider Details

I. General information

NPI: 1699716092
Provider Name (Legal Business Name): CATHERINE ANNE ACCURSO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/06/2023
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 THEATRE DR STE 500
ST AUGUSTINE FL
32086-3131
US

IV. Provider business mailing address

84 THEATRE DR STE 500
ST AUGUSTINE FL
32086-3131
US

V. Phone/Fax

Practice location:
  • Phone: 904-222-6440
  • Fax: 904-222-6450
Mailing address:
  • Phone: 305-962-5940
  • Fax: 904-222-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT13145
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT13145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: