MEDICARE: DIRECT 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	208100000X	Physical Medicine & Rehabilitation Physician	PT32520	FL
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1922506120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECT PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	1495 S VOLUSIA AVE STE 101
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7047
Country	:	US
Telephone Number	:	386-401-6100
Fax Number	:	386-960-0551

Provider Business Practice Location Address
First Line	:	1495 S VOLUSIA AVE STE 101
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7047
Country	:	US
Telephone Number	:	386-401-6100
Fax Number	:	386-960-0551

Authorized Official
Title or Position	:	OWNER
Name	:	JOCELYN BESA WHITE
Credential	:	PT, DPT, CLT
Telephone Number	:	386-401-6100

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	01/27/2023

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Directions to “DIRECT PHYSICAL THERAPY LLC ” Practice Location

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