Organization
DYNAMIC PHYSICAL THERAPY OF JACKSONVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ONOFRE FERNAN MIRANDA (PRESIDENT)
(904) 381-9207
Entity
Organization
Contact information
Practice address
1717 BLANDING BLVD, STE 104, JACKSONVILLE, FL 32210
(904) 381-9205
(904) 381-9208
Mailing address
1717 BLANDING BLVD, STE 104, JACKSONVILLE, FL 32210
(904) 381-9205
(904) 381-9208
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT10089
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y914M
BCBS
FL
Enumeration date
08/31/2006
Last updated
08/22/2020
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