Individual
KEVIN SHADDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
816 A1A N STE 307, PONTE VEDRA, FL 32082-3219
(402) 190-4543
Mailing address
3901 UNIVERSITY BLVD S, JACKSONVILLE, FL 32216-4312
(904) 345-7336
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PT33637
FL
Other
Enumeration date
07/31/2018
Last updated
07/31/2018
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