Healthcare Provider Details

I. General information

NPI: 1275576456
Provider Name (Legal Business Name): BENJAMIN SCOTT RAWITT DPT, MTC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOHNS MEDICAL PK DR
ST AUGUSTINE FL
32086-5300
US

IV. Provider business mailing address

1 SAINT JOHNS MEDICAL PK DR
ST AUGUSTINE FL
32086-5300
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-1958
  • Fax: 904-797-4926
Mailing address:
  • Phone: 904-797-1958
  • Fax: 904-797-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19637
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT19637
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT19637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: