Provider Demographics
NPI:1508883018
Name:PHYSICAL THERAPY ASSOCIATES OF ORANGE PARK, INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES OF ORANGE PARK, INC
Other - Org Name:PROGRESSIVE STEP REHAB OF ORANGE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEMANT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-264-6304
Mailing Address - Street 1:1550 BUSINESS CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4416
Mailing Address - Country:US
Mailing Address - Phone:904-276-7881
Mailing Address - Fax:904-276-7568
Practice Address - Street 1:1550 BUSINESS CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4416
Practice Address - Country:US
Practice Address - Phone:904-276-7881
Practice Address - Fax:904-276-7568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBCBSOtherY904K
FLBCBSOtherY904K
FLK1374Medicare PIN