Healthcare Provider Details

I. General information

NPI: 1558546184
Provider Name (Legal Business Name): JACKSONVILLE PHYSICAL THERAPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/25/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 GUM BRANCH RD SUITE 600
JACKSONVILLE NC
28540-4574
US

IV. Provider business mailing address

2453 GUM BRANCH RD STE 600
JACKSONVILLE NC
28540-4538
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-9800
  • Fax: 910-455-2083
Mailing address:
  • Phone: 910-353-9800
  • Fax: 910-455-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. MICHAEL C MINER
Title or Position: CFO
Credential: MPT
Phone: 910-353-9800