Organization
ACTIVE FOR LIFE REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEOFFREY GRAEME ANGELL PT (MANAGER)
(904) 891-1179
Entity
Organization
Contact information
Practice address
4164 LONICERA LOOP, SAINT JOHNS, FL 32259-4531
(904) 891-1179
(904) 212-1202
Mailing address
4164 LONICERA LOOP, SAINT JOHNS, FL 32259-4531
(904) 891-1179
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 21700
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010501000
—
FL
Enumeration date
03/05/2013
Last updated
07/21/2014
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