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NPI Code Detail

MEDICARE: JACKSONVILLE ORTHOPAEDIC INSTITUTE INC

MEDICARE: JACKSONVILLE ORTHOPAEDIC INSTITUTE 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
12255A2300XAthletic Trainer
2225X00000XOccupational Therapist
3225100000XPhysical Therapist

General Provider Information

NPI Number : 1154581379
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACKSONVILLE ORTHOPAEDIC INSTITUTE INC
Provider Business Mailing Address
First Line : PO BOX 117345
Second Line :
City : ATLANTA
State : GA
Zip : 30368-7345
Country : US
Telephone Number : 904-346-3465
Fax Number : 904-858-6489
Provider Business Practice Location Address
First Line : 12961 N MAIN ST
Second Line : SUITE 201 & 202
City : JACKSONVILLE
State : FL
Zip : 32218-2769
Country : US
Telephone Number : 904-757-2474
Fax Number : 904-757-5541
Authorized Official
Title or Position : ADMINISTRATOR
Name : TIMOTHY WALL
Credential :
Telephone Number : 904-858-7045
Provider Enumeration Date : 06/11/2008
Last Update Date : 01/24/2019

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Directions to “JACKSONVILLE ORTHOPAEDIC INSTITUTE INC ” Practice Location

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