MEDICARE: MRS. PENEMARIE KALLAS MURPHY 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
1	225100000X	Physical Therapist	0005355	FL

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

General Provider Information

NPI Number	:	1538160007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PENEMARIE KALLAS MURPHY PT

Provider Business Mailing Address
First Line	:	PO BOX 11677
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32239-1677
Country	:	US
Telephone Number	:	904-744-0277
Fax Number	:	904-744-0263

Provider Business Practice Location Address
First Line	:	7001 MERRILL RD STE 27
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2600
Country	:	US
Telephone Number	:	904-744-0277
Fax Number	:	904-744-0263

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/22/2022

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