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General NPI Number Information
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NPI Number | 1104867670
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Entity Type | Organization
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Legal Business Name | JANET S MOULTON INC
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 340 16TH AVE N STE B
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-4819
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Country | US
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Telephone | 904-249-8893
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Fax | 904-372-0496
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Provider Business Mailing Address
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Address Line | 340 16TH AVE N STE B
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-4819
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Country | US
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Telephone | 904-249-8893
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Fax | 904-372-0496
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Authorized Official
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Title or Position | OWNER
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Name | JANET S MOULTON
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Credential | SLP
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Telephone | 904-249-8893
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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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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA4951
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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