Provider Demographics
NPI:1093183519
Name:INTEGRATED PHYSICAL THERAPY SERVICES OF NORTH FLORIDA, LLC
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY SERVICES OF NORTH FLORIDA, LLC
Other - Org Name:BALANCED THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:904-412-2882
Mailing Address - Street 1:3948 3RD ST S # 133
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5847
Mailing Address - Country:US
Mailing Address - Phone:904-412-2882
Mailing Address - Fax:
Practice Address - Street 1:7230 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8330
Practice Address - Country:US
Practice Address - Phone:904-412-2882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty