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Organization
JACKSONVILLE ORTHOPAEDIC INSTITUTE INC
Active
Organization
JACKSONVILLE ORTHOPAEDIC INSTITUTE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY WALL MS, ATC (ADMINISTRATOR)
(904) 858-7045
Entity
Organization
Contact information
Practice address
203 FORT WADE RD UNIT 130, PONTE VEDRA, FL 32081-5159
(904) 686-3111
(904) 686-3140
Mailing address
PO BOX 117345, ATLANTA, GA 30368-7345
(904) 346-3465
(904) 858-6489
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
FL
225X00000X
Occupational Therapist
—
FL
Other
Enumeration date
06/22/2018
Last updated
01/08/2019
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