PALATKA PHYSICAL THERAPY LLC (NPI# 1619169661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619169661 |
| Entity Type | Organization |
| Organization Name | PALATKA PHYSICAL THERAPY LLC |
| Practice Address |
3715 Crill Ave Palatka FL 32177-9168 |
| Practice Telephone | 9133870679 |
| Practice Fax Number | 9133870879 |
| Mailing Telephone | 9133870679 |
| Mailing Fax Number | 9133870879 |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2008-04-18 |
| Authorized Official Name | MR. JOHN MILES FRISVOLD (OWNER/ADMINISTRATOR) |
| Authorized Official Telephone | 9133870679 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | AETNA PPO | 9120138 | 01 |
| FL | AETNA HMO | 1810605 | 01 |
| Street Address |
3715 CRILL AVE |
| City | PALATKA |
| State | FL |
| Zip Code | 32177-9168 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336230796 | John Miles Frisvold | Physical Therapist | 3715 Crill Ave, Palatka, FL 32177-9168 | 2006-09-28 |
| 1932641958 | Brittany Ann Crane | Physical Therapy Assistant | 3715 Crill Ave, Palatka, FL 32177-9168 | 2016-11-08 |
| 1629454806 | Jeffrey Bedenbaugh | Physical Therapist | 3715 Crill Ave, Palatka, FL 32177-9168 | 2015-08-10 |
| 1992196216 | Melinda Siehler | Specialist/Technologist | 3715 Crill Ave, Palatka, FL 32177-9168 | 2015-02-09 |
| 1356657407 | Melissa Faye Bowman | Physical Therapy Assistant | 3715 Crill Ave, Palatka, FL 32177-9168 | 2010-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174124176 | Charlie Douglas | Pharmacist | 1024 South State Road 19, Pharmacy, Palatka, FL 32177 | 2020-11-05 |
| 1275090359 | Carol M Kazounis | Dietitian, Registered | 2801 Kennedy Strett, Palatka, FL 32177 | 2019-02-26 |
| 1447744768 | Pulido Internal Medicine | Nurse Practitioner | 700 Zeagler Drive, Suite 1, Palatka, FL 32177 | 2018-06-20 |
| 1063922656 | Ronald Michael Wendt | Nurse Practitioner | 3703 Crill Ave, Palatka, FL 32177 | 2017-10-09 |
| 1043560212 | Leslie Ann Lewis | Massage Therapist | 325 Poinsetta Ave, Palatka, FL 32177 | 2012-09-14 |
| 1285984963 | Walgreens | Pharmacy | 719 South State Road 19, Palatka, FL 32177 | 2012-09-11 |
| 1841549235 | Audrey M Russell | Pharmacy Technician | 719 Hwy 19 South, Palatka, FL 32177 | 2012-08-31 |
| 1194023838 | Sherry D. Michael | Licensed Practical Nurse | 330 Kay Larkin Dr., Palatka, FL 32177 | 2011-03-04 |
| 1083846364 | Patricia Kowalchuk | Occupational Therapy Assistant | 6050 St.johns Ave., Suite A, Palatka, FL 32177 | 2009-08-20 |
| 1609015320 | Robin Calhoun | Occupational Therapist | 611 Zeagler Dr., Palatka, FL 32177 | 2009-02-19 |
| Find all providers in zip 32177 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528244761 | Gaylain Lee Shumacher Physical Therapist | Clinic/Center | 2722 Lane St, Palatka, FL 32177-2810 | 2008-01-17 |
| 1134266000 | Body Mechanics Therapy Incorporated | Clinic/Center | 1062 S State Road 19, Suite 1, Palatka, FL 32177-9050 | 2007-01-31 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.