MEDICARE: THERAFIT 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		FL

General Provider Information

NPI Number	:	1992210223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAFIT PHYSICAL THERAPY, LLC.

Provider Business Mailing Address
First Line	:	1755 MAYVIEW RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2219
Country	:	US
Telephone Number	:	904-868-9268
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 RIVERSIDE AVE STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4459
Country	:	US
Telephone Number	:	904-868-9268
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. STEPHANIE AMBRIDGE WILKINSON
Credential	:	MPT
Telephone Number	:	904-868-9268

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	01/19/2018

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