Provider Demographics
NPI:1821160110
Name:PHYSICAL THERAPY ASSOCIATES OF ORANGE PARK
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES OF ORANGE PARK
Other - Org Name:PROGRESSIVE STEP REHAB OF ORANGE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:N
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-264-6304
Mailing Address - Street 1:454 BLANDING BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5018
Mailing Address - Country:US
Mailing Address - Phone:904-276-7881
Mailing Address - Fax:
Practice Address - Street 1:1550 BUSINESS CENTER DR
Practice Address - Street 2:SUITE B
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-7450
Practice Address - Country:US
Practice Address - Phone:904-264-6304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY904LOtherBCBS
FLK1374Medicare ID - Type Unspecified