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General NPI Number Information
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NPI Number | 1184171605
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR HEALTH SPORTS SPINE REHABILITATION & PAIN MANAGE
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 1895 KINGSLEY AVE STE 1005B
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City | ORANGE PARK
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State | FL
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Zip | 32073-4466
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Country | US
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Telephone | 904-647-5266
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Fax | 904-770-5594
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Provider Business Mailing Address
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Address Line | 4100 SOUTHPOINT DR E STE 1
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8710
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Country | US
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Telephone | 904-647-5266
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Fax | 904-770-5594
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BRIDGET L. ROBERTS
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Credential |
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Telephone | 904-509-8739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME117856
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License Number State | FL
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