Healthcare Provider Details

I. General information

NPI: 1811143282
Provider Name (Legal Business Name): P3T LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2008
Last Update Date: 08/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ORCHIS RD
ST AUGUSTINE FL
32086-6521
US

IV. Provider business mailing address

121 ORCHIS RD
ST AUGUSTINE FL
32086-6521
US

V. Phone/Fax

Practice location:
  • Phone: 904-806-5583
  • Fax: 904-797-9711
Mailing address:
  • Phone: 904-806-5583
  • Fax: 904-797-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT18230
License Number StateFL

VIII. Authorized Official

Name: BRUCE D CATHCART
Title or Position: MGR
Credential: MPT
Phone: 904-806-5583