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General NPI Number Information
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NPI Number | 1134632474
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA SPORTS AND SPINE CENTER INC.
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 2758 US 1 S
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-6343
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Country | US
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Telephone | 904-429-7765
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Fax | 904-621-9202
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Provider Business Mailing Address
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Address Line | 2758 US 1 S
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-6343
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Country | US
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Telephone | 904-429-7765
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Fax | 904-621-9202
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA MICHAEL HENRY
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Credential | MD
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Telephone | 949-212-3425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | ME114798
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License Number State | FL
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