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General NPI Number Information
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NPI Number | 1346917663
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Entity Type | Organization
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Legal Business Name | TRISTAR THERAPY GROUP FL LLC
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 2100 A1A S SUITE 2
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City | ST. AUGUSTINE
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State | FL
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Zip | 32080
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Country | US
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Telephone | 904-419-9429
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Fax | 423-373-1351
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Provider Business Mailing Address
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Address Line | 2800 N 6TH ST # 788
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-1920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN BLACK
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Credential | PT, DPT
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Telephone | 904-419-9429
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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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