Active NPI
Gregory Ronald Trace, PT
- Physical Therapist
- Jacksonville, FL
National Provider Identifier
1346683448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT12276
- Practice address
- 2340 The Woods Dr
Jacksonville, FL 32246-1022 - Phone
- (904) 220-5699
- NPI assigned
- Apr 9, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT12276 | FL | Primary |
Addresses
Primary practice location
2340 The Woods Dr
Jacksonville, FL 32246-1022
Mailing address
2340 The Woods Dr
Jacksonville, FL 32246-1022
Phone (904) 220-5699
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365465600000",
"number": "1346683448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2340 THE WOODS DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322461022",
"telephone_number": "904-220-5699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2340 THE WOODS DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322461022",
"telephone_number": "904-220-5699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACE",
"first_name": "GREGORY",
"middle_name": "RONALD",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-09",
"last_updated": "2013-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT12276",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Apr 9, 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.