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General NPI Number Information
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NPI Number | 1780132662
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Entity Type | Organization
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Legal Business Name | VITAL REHABILITATION LLC
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 3600 PEORIA RD STE 202203
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City | ORANGE PARK
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State | FL
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Zip | 32065-7685
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Country | US
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Telephone | 904-657-0089
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Fax | 904-560-5283
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Provider Business Mailing Address
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Address Line | 2216 GREEN HERON CT
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-8600
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Country | US
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Telephone | 904-434-5737
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Fax | 904-512-3808
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | JENNIFER JUSTICE
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Credential | DPT
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Telephone | 904-434-5737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports 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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT28237
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License Number State | FL
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