Provider Demographics
NPI:1508466707
Name:A1A PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:A1A PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:904-874-8547
Mailing Address - Street 1:358 MISSION TRACE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1154
Mailing Address - Country:US
Mailing Address - Phone:904-874-8547
Mailing Address - Fax:904-780-5426
Practice Address - Street 1:8 OCEAN TRACE RD
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6972
Practice Address - Country:US
Practice Address - Phone:904-874-8547
Practice Address - Fax:904-780-5426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation