NPIMap

Organization Active NPI

Jacksonville Orthopaedic Institute Inc

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1346399698
Registry record updated Jan 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
JACKSONVILLE ORTHOPAEDIC INSTITUTE INC
Practice address
14985 Old Saint Augustine Rd
Suite 106
Jacksonville, FL 32258-9477
Phone
(904) 288-9491
Fax
(904) 288-9698
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2019

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

Authorized official

Name
Mr. Timothy Edwin Wall, MS, ATC
Title
Administrator
Phone
(904) 858-7045

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Athletic TrainerGroup: 193200000X MULTI-SPECIALTY GROUP 2255A2300X AL351 FL
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

14985 Old Saint Augustine Rd
Suite 106
Jacksonville, FL 32258-9477

Mailing address

PO Box 117345
Atlanta, GA 30368-7345
Phone (904) 346-3465

Other names 1

  • Jacksonville Orthopaedic Institute Rehabilitation Other name

National Provider Directory

National Provider Directory
Tax ID family
Jacksonville Orthopaedic Institute Inc27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

14985 Old St Augustine Rd
Unit 106
Jacksonville, FL 32258
Phone (904) 288-9491

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548288000000",
    "number": "1346399698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 117345",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303687345",
            "telephone_number": "904-346-3465",
            "fax_number": "904-858-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14985 OLD SAINT AUGUSTINE RD",
            "address_2": "SUITE 106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322589477",
            "telephone_number": "904-288-9491",
            "fax_number": "904-288-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE ORTHOPAEDIC INSTITUTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2019-01-24",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-858-7045",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, ATC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL351",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacksonville Orthopaedic Institute Rehabilitation",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Jacksonville Orthopaedic Institute Rehabilitation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; 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.