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General NPI Number Information
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NPI Number | 1003823709
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Entity Type | Organization
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Legal Business Name | FIRST COAST PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 2630 US 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6191
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Country | US
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Telephone | 904-829-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 2630 US 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6191
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Country | US
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Telephone | 904-829-3411
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Fax | 904-829-3412
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Authorized Official
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Title or Position | OWNER
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Name | BRYAN OLSON
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Credential | PT
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Telephone | 904-829-3411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 18156
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License Number State | FL
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