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Organization
JUDO RYU JACKSONVILLE, INC
Active
Organization
JUDO RYU JACKSONVILLE, INC
Active
Other names
Gentle Way Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MANCHESTER (BILLING AGENT)
(904) 777-5002
Entity
Organization
Contact information
Practice address
1241 MAYPORT RD, ATLANTIC BEACH, FL 32233-3435
(904) 349-0990
(866) 737-1635
Mailing address
691 SELVA LAKES CIR, ATLANTIC BEACH, FL 32233-7326
(904) 349-0990
(866) 737-1635
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT7180
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y4214
BC/BS OF FLORIDA
FL
Enumeration date
10/19/2007
Last updated
04/20/2008
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