Provider Demographics
NPI:1912253030
Name:PHYSICAL THERAPY AND REHABILITATION CLINIC INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND REHABILITATION CLINIC INC
Other - Org Name:PREFERRED PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:904-272-2830
Mailing Address - Street 1:1075 OAKLEAF PLANTATION PARKWAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065
Mailing Address - Country:US
Mailing Address - Phone:904-282-8196
Mailing Address - Fax:904-282-8197
Practice Address - Street 1:1075 OAKLEAF PLANTATION PARKWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065
Practice Address - Country:US
Practice Address - Phone:904-282-8196
Practice Address - Fax:904-282-8197
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICAL THERAPY AND REHABILITATION CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty