Healthcare Provider Details

I. General information

NPI: 1245708775
Provider Name (Legal Business Name): MSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 PARK BLVD N
VENICE FL
34285-1628
US

IV. Provider business mailing address

209 PARK BLVD N
VENICE FL
34285-1628
US

V. Phone/Fax

Practice location:
  • Phone: 904-504-2332
  • Fax: 941-237-4186
Mailing address:
  • Phone: 904-504-2332
  • Fax: 941-237-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS MARGARET ASHLEY WILLIAMS
Title or Position: OWNER
Credential: PT, DPT, ATP
Phone: 904-504-2332