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General NPI Number Information
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NPI Number | 1336337864
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Entity Type | Organization
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Legal Business Name | ATLANTIC COAST PHYSICAL THERAPY SERVICES LLC
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 13595 ATLANTIC BLVD SUITE B
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City | JACKSONVILLE
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State | FL
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Zip | 32225-3256
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Country | US
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Telephone | 904-221-4046
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Fax | 904-221-4056
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Provider Business Mailing Address
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Address Line | 13595 ATLANTIC BLVD SUITE B
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City | JACKSONVILLE
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State | FL
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Zip | 32225-3256
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Country | US
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Telephone | 904-221-4046
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Fax | 904-221-4056
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DELL A JARVIS
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Credential | PTA
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Telephone | 904-221-4046
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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 | PT20519
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License Number State | FL
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