Healthcare Provider Details

I. General information

NPI: 1114745130
Provider Name (Legal Business Name): KAYLIE MACGREGOR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 SOUTHPARK BLVD STE 100
ST AUGUSTINE FL
32086-4209
US

IV. Provider business mailing address

3901 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4312
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-1478
  • Fax:
Mailing address:
  • Phone: 904-345-7251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42083
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: