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General NPI Number Information
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NPI Number | 1558917484
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Entity Type | Organization
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Legal Business Name | PRIZM HEALTHCARE SERVICES PA
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Dates
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Enumeration Date | 08/15/2019
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 229 GOLDEN OAKS LN
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-6111
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Country | US
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Telephone | 661-476-7051
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Fax | 904-471-8569
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Provider Business Mailing Address
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Address Line | 229 GOLDEN OAKS LN
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-6111
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Country | US
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Telephone | 904-806-6403
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Fax | 904-471-8569
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Authorized Official
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Title or Position | PRESIDENT AND DIRECTOR
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Name | WILLIAM REGAN
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Credential | PHYSICAL THERAPIST
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Telephone | 904-806-6403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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