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General NPI Number Information
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NPI Number | 1598348948
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Entity Type | Individual
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Provider Name | NANCY LEA POWLIN DPT, PT
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Gender | Female
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 05/08/2021
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Provider Practice Location Address
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Address Line | 9560 CROSSHILL BLVD STE 110
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City | JACKSONVILLE
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State | FL
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Zip | 32222-5827
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Country | US
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Telephone | 904-203-1296
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Fax |
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Provider Business Mailing Address
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Address Line | 816 PLAINFIELD AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-3911
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Country | US
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Telephone | 904-607-4774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT36797
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License Number State | FL
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