Basic Information
| Provider Information | |||||||||
| NPI: | 1124274881 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPYWORKS OF JACKSONVILLE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 HENDRICKS AVE | ||||||||
| Address2: | SUITES 2 AND 3 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322073303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043485511 | ||||||||
| FaxNumber: | 9043486601 | ||||||||
| Practice Location | |||||||||
| Address1: | 1409 KINGSLEY AVE | ||||||||
| Address2: | BLDG 3, SUITE A | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320734537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043485511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | LEHMAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9043485511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | BK346 | 01 | MEDICARE | OTHER |