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NPI Code Detail

MEDICARE: MS. LAUREN SURDYKE DPT

MEDICARE: MS. LAUREN SURDYKE DPT
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 Therapist30389FL

General Provider Information

NPI Number : 1467834986
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAUREN SURDYKE DPT
Provider Business Mailing Address
First Line : 1588 RIVERTRACE DR
Second Line :
City : ORANGE PARK
State : FL
Zip : 32003-7777
Country : US
Telephone Number : 904-710-5044
Fax Number :
Provider Business Practice Location Address
First Line : 14286 BEACH BLVD STE 34
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32250-1570
Country : US
Telephone Number : 904-345-7510
Fax Number : 904-345-7540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2015
Last Update Date : 06/20/2015

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Directions to “ MS. LAUREN SURDYKE DPT” Practice Location

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