Healthcare Provider Details

I. General information

NPI: 1598558637
Provider Name (Legal Business Name): WESTON ALEXANDER HUTT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 COUNTY ROAD 210 W STE 110
ST JOHNS FL
32259-7001
US

IV. Provider business mailing address

3055 COUNTY ROAD 210 W STE 110
ST JOHNS FL
32259-7001
US

V. Phone/Fax

Practice location:
  • Phone: 904-634-0640
  • Fax: 904-634-0203
Mailing address:
  • Phone: 904-634-0640
  • Fax: 904-634-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43101
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: