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General NPI Number Information
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NPI Number | 1508466707
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Entity Type | Organization
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Legal Business Name | A1A PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 8 OCEAN TRACE RD
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-6972
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Country | US
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Telephone | 904-874-8547
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Fax | 904-780-5426
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Provider Business Mailing Address
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Address Line | 358 MISSION TRACE DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-1154
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Country | US
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Telephone | 904-874-8547
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Fax | 904-780-5426
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. HOLLY FAUNCE
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Credential | DPT
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Telephone | 904-874-8547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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