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NPI Code Detail

MEDICARE: DEBORAH JANET ROCKETT PT

MEDICARE:   DEBORAH JANET ROCKETT  PT
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
1225100000XPhysical TherapistPT12110FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00066071OTHERFLRR MEDICARE

General Provider Information

NPI Number : 1174528566
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH JANET ROCKETT PT
Provider Business Mailing Address
First Line : PO BOX 40767
Second Line : CREDENTIALING DEPARTMENT
City : JACKSONVILLE
State : FL
Zip : 32203-0767
Country : US
Telephone Number : 904-376-3707
Fax Number : 904-391-5807
Provider Business Practice Location Address
First Line : 1325 SAN MARCO BLVD STE 102
Second Line : CREDENTIALING DEPARTMENT
City : JACKSONVILLE
State : FL
Zip : 32207-8549
Country : US
Telephone Number : 904-858-7045
Fax Number : 904-858-7047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 02/04/2015

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Directions to “ DEBORAH JANET ROCKETT PT” Practice Location

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