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General NPI Number Information
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NPI Number | 1831961085
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Entity Type | Organization
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Legal Business Name | MIKSELL PHYSICAL THERAPY & WELLNESS
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 13241 BARTRAM PARK BLVD UNIT 609
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5214
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Country | US
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Telephone | 904-662-0868
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Fax |
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Provider Business Mailing Address
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Address Line | 10977 MANDARIN STATION DR W
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City | JACKSONVILLE
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State | FL
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Zip | 32257-3901
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Country | US
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Telephone | 904-662-0868
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTIONER
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Name | TAYLOR MIKSELL
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Credential | PT, DPT
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Telephone | 904-662-0868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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