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General NPI Number Information
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NPI Number | 1609441989
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Entity Type | Organization
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Legal Business Name | ELITE ENDURANCE PHYSIO LLC
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 616 10TH AVE N
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-4746
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Country | US
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Telephone | 904-885-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 616 10TH AVE N
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-4746
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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 | PHYSICAL THERAPIST
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Name | JOSHUA SMITH
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Credential | PT
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Telephone | 904-885-6118
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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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