Provider Demographics
NPI:1255912556
Name:O'LESSKER COLLECTIVE
Entity type:Organization
Organization Name:O'LESSKER COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:O'LESSKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:904-655-4596
Mailing Address - Street 1:2608 DUPONT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2633
Mailing Address - Country:US
Mailing Address - Phone:904-655-4596
Mailing Address - Fax:
Practice Address - Street 1:2608 DUPONT AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2633
Practice Address - Country:US
Practice Address - Phone:904-655-4596
Practice Address - Fax:904-539-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty