Healthcare Provider Details

I. General information

NPI: 1386469625
Provider Name (Legal Business Name): PHYSICAL THERAPY ON DEMAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 HIGH TIDE DR STE 101A
ST AUGUSTINE FL
32080-2324
US

IV. Provider business mailing address

320 HIGH TIDE DR STE 101A
ST AUGUSTINE FL
32080-2324
US

V. Phone/Fax

Practice location:
  • Phone: 904-599-6812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TODD BALL
Title or Position: PRESIDENT
Credential: PT
Phone: 904-599-6812