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General NPI Number Information
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NPI Number | 1780835439
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE ORTHOPAEDIC INSTITUTE INC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 12276 SAN JOSE BLVD SUITE 716 & 717
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8628
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Country | US
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Telephone | 904-288-9604
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Fax | 904-288-9643
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Provider Business Mailing Address
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Address Line | PO BOX 117345
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City | ATLANTA
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State | GA
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Zip | 30368-7345
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Country | US
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Telephone | 904-346-3465
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Fax | 904-858-6489
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TIMOTHY WALL
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Credential |
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Telephone | 904-858-7045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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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 | 225X00000X
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Taxonomy Name | Occupational 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 |
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License Number State |
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