=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801790852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULCRUM PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2026
-----------------------------------------------------
Last Update Date | 10/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3973 EAGLE LANDING PKWY UNIT 1
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32065-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-354-8154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1281 AUTUMN PINES DR
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32065-2693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-354-8154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. HUSSEIN EID
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 201-354-8154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------