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General NPI Number Information
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NPI Number | 1255912556
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Entity Type | Organization
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Legal Business Name | O'LESSKER COLLECTIVE
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 2608 DUPONT AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2633
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Country | US
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Telephone | 904-655-4596
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Fax | 904-539-5645
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Provider Business Mailing Address
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Address Line | 2608 DUPONT AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2633
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Country | US
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Telephone | 904-655-4596
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT/OWNER
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Name | CHRISTOPHER O'LESSKER
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Credential | DPT
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Telephone | 904-655-4596
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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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