Organization
PROVIDIAN FUNCTIONAL CAPACITY SPECIALISTS
Active
Other names
Providian Physical Therapy and Functional Capacity Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN SCOTT IMLER BA, A.T.,C/L (PRESIDENT)
(904) 982-5762
Entity
Organization
Contact information
Practice address
716 N ORANGE AVE, GREEN COVE SPRINGS, FL 32043-2920
(888) 957-3337
(904) 284-4244
Mailing address
716 N ORANGE AVE, GREEN COVE SPRINGS, FL 32043-2920
(888) 957-3337
(904) 284-4244
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
AL1714
FL
Other
Enumeration date
03/04/2013
Last updated
03/04/2013
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