Basic Information
| Provider Information | |||||||||
| NPI: | 1831624527 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PT SOLUTIONS OF PENSACOLA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 441146 | ||||||||
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| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301609522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784033632 | ||||||||
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| Practice Location | |||||||||
| Address1: | 236 PONTE VEDRA PARK DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PONTE VEDRA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320826619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789323629 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2017 | ||||||||
| LastUpdateDate: | 05/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | JAMESON | ||||||||
| AuthorizedOfficialFirstName: | KELLEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6789323629 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.