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General NPI Number Information
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NPI Number | 1518054758
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Entity Type | Organization
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Legal Business Name | DUNN AVENUE PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 06/01/2009
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Provider Practice Location Address
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Address Line | 2377 DUNN AVE SUITE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32218-6983
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Country | US
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Telephone | 904-751-6646
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Fax | 904-751-6647
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Provider Business Mailing Address
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Address Line | 2377 DUNN AVE STE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32218-6984
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Country | US
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Telephone | 904-751-6646
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Fax | 904-751-6647
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | REIN VANDERVELDE
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Credential | PT
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Telephone | 904-751-6646
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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 | PT5670
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License Number State | FL
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