Healthcare Provider Details

I. General information

NPI: 1508433715
Provider Name (Legal Business Name): FREEDOM PHYSIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LIBERTY CENTER PL
ST AUGUSTINE FL
32092-0919
US

IV. Provider business mailing address

23 SAN BRISO WAY
ST AUGUSTINE FL
32092-3117
US

V. Phone/Fax

Practice location:
  • Phone: 904-392-1715
  • Fax:
Mailing address:
  • Phone: 410-409-5447
  • 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: ERIC T UVEGES
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 410-409-5447