Organization
PROVIDIAN FUNCTIONAL CAPACITY SPECIALISTS
Active
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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