MEDICARE: JUDO RYU JACKSONVILLE, INC

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	PT7180	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y4214	OTHER	FL	BC/BS OF FLORIDA

General Provider Information

NPI Number	:	1982893509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDO RYU JACKSONVILLE, INC

Provider Business Mailing Address
First Line	:	691 SELVA LAKES CIR
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-7326
Country	:	US
Telephone Number	:	904-349-0990
Fax Number	:	866-737-1635

Provider Business Practice Location Address
First Line	:	1241 MAYPORT RD
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-3435
Country	:	US
Telephone Number	:	904-349-0990
Fax Number	:	866-737-1635

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	SUSAN MANCHESTER
Credential	:
Telephone Number	:	904-777-5002

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	04/20/2008

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1982698510 — JOHN C FIEGE PT
Practice Location Address:

1241 MAYPORT RD
ATLANTIC BEACH, FL
32233-3435

Practice Phone: 904-349-0990
Practice Fax: 904-246-1578

1396732038 — GERARDO C PEREZ D.O.
Practice Location Address:

3435 NE 163RD ST
NORTH MIAMI BEACH, FL
33160-4426

Practice Phone: 305-947-3700
Practice Fax: 305-947-9610

1851344493 — JEFFREY L. LEBOW D.O.
Practice Location Address:

3435 NE 163RD ST
NORTH MIAMI BEACH, FL
33160-4426

Practice Phone: 305-947-3700
Practice Fax:

1053422873 — MRS. FIDA SHAKER SAKALLAH-SIAM PHARMD
Practice Location Address:

3435 N FEDERAL HWY
POMPANO BEACH, FL
33064-6605

Practice Phone: 954-781-0442
Practice Fax: 954-781-8595

1841397015 — MS. MARGARITA G MAS RPH
Practice Location Address:

3435 N FEDERAL HIGHWAY
POMPANO BEACH, FL
33064

Practice Phone: 954-781-0442
Practice Fax: 954-781-8595

Directions to “JUDO RYU JACKSONVILLE, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.