Provider Demographics
NPI:1649563263
Name:PINNACLE PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
Entity Type:Organization
Organization Name:PINNACLE PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
Other - Org Name:PINNACLE PHYSICAL THERAPY & SPORTS PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-894-8789
Mailing Address - Street 1:2758 RACE TRACK RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2758 RACE TRACK RD
Practice Address - Street 2:SUITE 401
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3250
Practice Address - Country:US
Practice Address - Phone:904-894-8789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty