Jeanette Carlsen

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

300967 Issued in CA

Practice address

425 N Ocean Grande Dr Unit 204
Ponte Vedra Beach, FL 32082-6524

Phone

(904) 517-9510

NPI assigned

Apr 15, 2021

Last updated

Apr 1, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1487235123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N OCEAN GRANDE DR UNIT 204",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320826524",
            "telephone_number": "904-517-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 N OCEAN GRANDE DR UNIT 204",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320826524",
            "telephone_number": "904-517-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSEN",
        "first_name": "JEANETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-15",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "36647",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "300967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Buster, RBT
• Daniel M Calloway, MD
• Katie Longo Cantrell, MD
• Mark A Cappel, MD
• Victor M Cardenas, M.D.
• Mackenzie Carr
• Levan A Carter
• Michael Edward Carver, H.A.S.
• Shirley Casillas
• Claire Castellano, LPC

• Physical Therapist in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2025; 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.