| Organization Name: | PONTE VEDRA PHYSICAL THERAPY, INC. |
| NPI Number: | 1043246580 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY C PARKS (PRESIDENT) |
| Mailing Address: | 880 A1a N Suite 18a Ponte Vedra Beach |
| State: | FL US |
| Postal Code: | 320823221 |
| Phone Number: | 9042852910 |
| Fax Number: | 9042854663 |
| NPI Enumeration Date: | 06/25/2006 |
| NPI Last Update Date: | 12/07/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |