Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
Aug 30, 2006
License(s)
PT12830 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1325 SAN MARCO BLVD SUITE 200 | Jacksonville, FL 32207-8568 | 904-346-3465 |
| LOCATION | 1325 SAN MARCO BLVD SUITE 102 | Jacksonville, FL 32207-8568 | 904-557-9021 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.