MEDICARE: EMPOWER WELLNESS AND PHYSICAL THERAPY LLC

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	:	1578248555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWER WELLNESS AND PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	2692 KIMBERLY FOREST DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9575
Country	:	US
Telephone Number	:	386-205-1048
Fax Number	:

Provider Business Practice Location Address
First Line	:	2692 KIMBERLY FOREST DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9575
Country	:	US
Telephone Number	:	386-205-1048
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HANNAH LEE RAWLINGS
Credential	:
Telephone Number	:	386-205-1048

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/19/2023

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