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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 E WALL MS, ATC (ADMINISTRATOR)
(904) 858-7045
Entity
Organization
Contact information
Practice address
1348 S 18TH ST, SUITE 320A, FERNANDINA BEACH, FL 32034-4785
(904) 557-9021
(904) 557-9022
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
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC4257
RR MEDICARE
FL
Enumeration date
03/01/2016
Last updated
01/08/2019
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