Provider Demographics
NPI:1881968451
Name:HEALTH POINT INJURY CENTER, LLC.
Entity type:Organization
Organization Name:HEALTH POINT INJURY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DE LA PENA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:904-683-3205
Mailing Address - Street 1:6817 SOUTHPOINT PKWY
Mailing Address - Street 2:SUITE 2303
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6282
Mailing Address - Country:US
Mailing Address - Phone:904-683-3205
Mailing Address - Fax:904-683-3384
Practice Address - Street 1:6817 SOUTHPOINT PKWY
Practice Address - Street 2:SUITE 2303
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6282
Practice Address - Country:US
Practice Address - Phone:904-683-3205
Practice Address - Fax:904-683-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9772261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center