| Organization Name: | JUDO RYU JACKSONVILLE, INC |
| NPI Number: | 1982893509 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN MANCHESTER (BILLING AGENT) |
| Mailing Address: | 1241 Mayport Rd Atlantic Beach |
| State: | FL US |
| Postal Code: | 322333435 |
| Phone Number: | 9043490990 |
| Fax Number: | 8667371635 |
| NPI Enumeration Date: | 10/19/2007 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT7180 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |