| NPI | 1013258862 |
|---|---|
| Doing Business As | PROVIDIAN PHYSICAL THERAPY AND FUNCTIONAL CAPACITY SPECIALISTS |
| Entity Type | Organization |
| Authorized Contact | BRIAN SCOTT IMLER President 904-982-5762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: FL al1714) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2013-03-04 |