Healthcare Provider Details

I. General information

NPI: 1003823709
Provider Name (Legal Business Name): FIRST COAST PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 US 1 S
ST AUGUSTINE FL
32086-6191
US

IV. Provider business mailing address

2630 US 1 S
ST AUGUSTINE FL
32086-6191
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-3411
  • Fax:
Mailing address:
  • Phone: 904-829-3411
  • Fax: 904-829-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number18156
License Number StateFL

VIII. Authorized Official

Name: BRYAN OLSON
Title or Position: OWNER
Credential: PT
Phone: 904-829-3411