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General NPI Number Information
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NPI Number | 1275083206
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Entity Type | Organization
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Legal Business Name | INNER STRENGTH PHYSICAL THERAPY, LLC.
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 64 TARPON BAY CT
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City | PONTE VEDRA
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State | FL
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Zip | 32081-1505
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Country | US
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Telephone | 440-463-6272
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Fax |
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Provider Business Mailing Address
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Address Line | 64 TARPON BAY CT
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City | PONTE VEDRA
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State | FL
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Zip | 32081-1505
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Country | US
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Telephone | 440-463-6272
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | SAMANTHA JOY MOON
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Credential | DPT
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Telephone | 440-463-6272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT27447
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License Number State | FL
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