Valdora L Bollenback, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT25646 Issued in FL

Practice address

910 N Jefferson St
Jacksonville, FL 32209-6810

Phone

(904) 360-7022

Fax

(904) 798-4545

NPI assigned

Jan 17, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361145600000",
    "number": "1114265709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 N JEFFERSON ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096810",
            "telephone_number": "904-360-7022",
            "fax_number": "904-798-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 N JEFFERSON ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096810",
            "telephone_number": "904-360-7022",
            "fax_number": "904-798-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLENBACK",
        "first_name": "VALDORA",
        "middle_name": "L",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-17",
        "last_updated": "2013-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT25646",
            "primary": true
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William E Bolger, M.D.
• Kylee Waynette Bolibrzuch, MSW
• Laura Stultz Bolinski
• Kelsey Lyn Bolks, M.A., CCC-SLP
• Rishitha Bollam, MD
• James Bolling, MD
• Jasmine R Bolling
• Justin Tyler Bollingmo, LMFT
• Emma Boloutchi
• Bolt Behavior Services

• Physical Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.