Provider Demographics
NPI:1598399651
Name:ATLANTIC COAST PHYSICAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ATLANTIC COAST PHYSICAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCALISTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-221-4046
Mailing Address - Street 1:13595 ATLANTIC BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3256
Mailing Address - Country:US
Mailing Address - Phone:904-221-4046
Mailing Address - Fax:
Practice Address - Street 1:720 SAINT JOHNS BLUFF RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6704
Practice Address - Country:US
Practice Address - Phone:904-221-4046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC COAST PHYSICAL THERAPY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY930BOtherFLORIDA BLUE