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General NPI Number Information
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NPI Number | 1073261897
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Entity Type | Organization
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Legal Business Name | PREVAIL THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 22 BERMUDA GREENS AVE
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City | PONTE VEDRA
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State | FL
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Zip | 32081-4370
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Country | US
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Telephone | 904-208-8811
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Fax | 904-814-8953
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Provider Business Mailing Address
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Address Line | 22 BERMUDA GREENS AVE
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City | PONTE VEDRA
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State | FL
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Zip | 32081-4370
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Country | US
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Telephone | 904-208-8811
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Fax | 904-814-8953
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Authorized Official
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Title or Position | OWNER/PHYSCIAL THERAPIST
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Name | TORI S MILLER
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Credential |
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Telephone | 904-208-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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