Organization
PALATKA PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN MILES FRISVOLD PT (OWNER/ADMINISTRATOR)
(913) 387-0679
Entity
Organization
Contact information
Practice address
3715 CRILL AVE, PALATKA, FL 32177-9168
(913) 387-0679
(913) 387-0879
Mailing address
3715 CRILL AVE, PALATKA, FL 32177-9168
(913) 387-0679
(913) 387-0879
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1810605
AETNA HMO
FL
01
—
9120138
AETNA PPO
FL
Enumeration date
08/14/2007
Last updated
04/18/2008
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