Healthcare Provider Details

I. General information

NPI: 1932015666
Provider Name (Legal Business Name): IRELAND SHAE JARVIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STATE ROAD 13 N
ST JOHNS FL
32259-3860
US

IV. Provider business mailing address

5085 BIG OAK RD S
SAINT AUGUSTINE FL
32095-6234
US

V. Phone/Fax

Practice location:
  • Phone: 904-900-5512
  • Fax:
Mailing address:
  • Phone: 904-563-5655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number45288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: