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General NPI Number Information
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NPI Number | 1306462270
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Entity Type | Organization
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Legal Business Name | JANET MOULTON, INC.
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 13453 N MAIN ST STE 401
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2774
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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 | BILLING AGENT
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Name | CHARLOTTE LAVERGNE
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Credential |
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Telephone | 904-879-4230
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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 |
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License Number State |
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