MEDICARE: O'LESSKER COLLECTIVE

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

General Provider Information

NPI Number	:	1255912556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O'LESSKER COLLECTIVE

Provider Business Mailing Address
First Line	:	2608 DUPONT AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2633
Country	:	US
Telephone Number	:	904-655-4596
Fax Number	:

Provider Business Practice Location Address
First Line	:	2608 DUPONT AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2633
Country	:	US
Telephone Number	:	904-655-4596
Fax Number	:	904-539-5645

Authorized Official
Title or Position	:	REGISTERED AGENT/OWNER
Name	:	CHRISTOPHER O'LESSKER
Credential	:	DPT
Telephone Number	:	904-655-4596

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	04/19/2021

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Directions to “O'LESSKER COLLECTIVE ” Practice Location

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