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Organization
SOUTHERN THERAPIES OF NORTH FLORIDA INC
Active
Organization
SOUTHERN THERAPIES OF NORTH FLORIDA INC
Active
Other names
Southern Therapy and Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA BENNETT (BILLING AGENT)
(386) 312-0022
Entity
Organization
Contact information
Practice address
6050 SAINT JOHNS AVE, SUITE 1, PALATKA, FL 32177-3895
(386) 312-0022
(386) 312-0535
Mailing address
6050 SAINT JOHNS AVE, SUITE 1, PALATKA, FL 32177-3895
(386) 312-0022
(386) 312-0535
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
376J00000X
Homemaker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6762204-00
—
FL
05
—
884914500
—
FL
Enumeration date
09/08/2005
Last updated
08/12/2010
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