MEDICARE: JANET S MOULTON INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist	SA4951	FL
4	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	S1828	OTHER	FL	BC/BS

General Provider Information

NPI Number	:	1104867670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANET S MOULTON INC

Provider Business Mailing Address
First Line	:	340 16TH AVE N
Second Line	:	STE B
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4819
Country	:	US
Telephone Number	:	904-249-8893
Fax Number	:	904-372-0496

Provider Business Practice Location Address
First Line	:	340 16TH AVE N
Second Line	:	STE B
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4819
Country	:	US
Telephone Number	:	904-249-8893
Fax Number	:	904-372-0496

Authorized Official
Title or Position	:	OWNER
Name	:	JANET S MOULTON
Credential	:	SLP
Telephone Number	:	904-249-8893

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	10/25/2022

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Directions to “JANET S MOULTON INC ” Practice Location

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