Provider Demographics
NPI:1508929779
Name:PHYSICAL THERAPY AND REHABILIATION CLINIC INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND REHABILIATION CLINIC INC
Other - Org Name:FLEMING ISLAND ORTHOPEDIC AND SPORTS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-214-3958
Mailing Address - Street 1:1835 EAST WEST PARKWAY
Mailing Address - Street 2:16
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:904-215-3958
Mailing Address - Fax:904-215-3970
Practice Address - Street 1:1835 EAST WEST PARKWAY
Practice Address - Street 2:16
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003
Practice Address - Country:US
Practice Address - Phone:904-215-3958
Practice Address - Fax:904-215-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty