Provider Demographics
NPI:1598348948
Name:POWLIN, NANCY LEA (DPT, PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LEA
Last Name:POWLIN
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 PLAINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-3911
Mailing Address - Country:US
Mailing Address - Phone:904-607-4774
Mailing Address - Fax:
Practice Address - Street 1:9560 CROSSHILL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-5827
Practice Address - Country:US
Practice Address - Phone:904-203-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FLPT36797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist