Provider Demographics
NPI:1285204842
Name:DELIVER PT, LLC
Entity Type:Organization
Organization Name:DELIVER PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:UPDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:434-841-1820
Mailing Address - Street 1:514 CROSS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8465
Mailing Address - Country:US
Mailing Address - Phone:434-841-1820
Mailing Address - Fax:
Practice Address - Street 1:514 CROSS RIDGE DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-8465
Practice Address - Country:US
Practice Address - Phone:434-841-1820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty