Physical Healthcare Of Jacksonville Inc
Legal Business Name
Physical Healthcare Of Jacksonville Inc
NPI Number
1760722011
NPI Type
Organization
Enumeration Date
02/25/2013
Specialties
(Taxonomies)Name
Code
111N00000X
332B00000X
363LF0000X
363AM0700X
208100000X
225100000X
Primary Taxonomy
No
No
No
No
No
No
Licenses
State
Florida
Florida
Florida
Florida
Florida
Florida
Florida
Florida
License Number
CH6451
CH6588
CH4435
ME55161
ME0060908
ARNP 770742
PA9106788
PT30658
Contact
Information
Purpose
Mailing
Location
Address
12620 BEACH BLVD
12620 BEACH BLVD
City
Jacksonville
Jacksonville
State
FL
FL
Postal Code
32246-7131
32246-7131
Country
US
US
Telephone Number
(904) 645-0777
(904) 645-0777
Authorized Official
Name
Mark Pierce
Title or Position
CLINIC DIRECTOR
Telephone Number
(904) 645-0777
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 04/18/2017