Provider Demographics
NPI:1689707119
Name:PHYSIOPOWER, LLC
Entity Type:Organization
Organization Name:PHYSIOPOWER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-230-7148
Mailing Address - Street 1:249 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4215
Mailing Address - Country:US
Mailing Address - Phone:904-230-7148
Mailing Address - Fax:904-230-7148
Practice Address - Street 1:249 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-4215
Practice Address - Country:US
Practice Address - Phone:904-230-7148
Practice Address - Fax:904-230-7148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty