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General NPI Number Information
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NPI Number | 1649563263
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Entity Type | Organization
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Legal Business Name | PINNACLE PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 2758 RACE TRACK RD SUITE 401
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City | SAINT JOHNS
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State | FL
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Zip | 32259-3250
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Country | US
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Telephone | 904-894-8789
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Fax |
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Provider Business Mailing Address
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Address Line | 2758 RACE TRACK RD SUITE 401
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City | SAINT JOHNS
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State | FL
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Zip | 32259-3250
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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 | CEO
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Name | FREDERICK BALDWIN
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Credential | P.T.
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Telephone | 904-894-8789
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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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