Physiatry Consults of Jacksonville. LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

PHYSIATRY CONSULTS OF JACKSONVILLE. LLC

Practice address

1750 Stockton St
Jacksonville, FL 32204-4664

Phone

(190) 486-0112

NPI assigned

Aug 1, 2018

Last updated

Aug 1, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Natalya Bulaeva Bulaeva, MD

Title

MGR

Phone

(904) 860-1123

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1533081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533081600000",
    "number": "1437637402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 BAYTREE LN",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824162",
            "telephone_number": "904-860-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 STOCKTON ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044664",
            "telephone_number": "190-486-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIATRY CONSULTS OF JACKSONVILLE. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-01",
        "last_updated": "2018-08-01",
        "status": "A",
        "authorized_official_last_name": "BULAEVA",
        "authorized_official_first_name": "NATALYA",
        "authorized_official_middle_name": "BULAEVA",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "904-860-1123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003169167A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Davong David Phrathep, DO
• Hong Phung
• Lauren Phung, MD
• Phuong Lu DO PA
• Jennifer Christine Phuong, LCSW
• Physical Healthcare of Jacksonville Inc
• Physical Medicine Specialists, Inc. (Brooks Rehabilitation Medical Group)
• Physical Therapy Associates of Orange Park, Inc
• Physical Therapy Masters, PA
• Physical Therapy Now Holdings LLC (Physical Therapy Now Jacksonville)

• Physical Medicine & Rehabilitation Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physical Medicine & Rehabilitation Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; 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.