NPIMap

Organization Active NPI

Jacksonville Orthopaedic Institute Inc

  • Physical Therapist
  • Jacksonville Beach, FL
National Provider Identifier
1902954332
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
1577 Roberts Dr
Suite 320
Jacksonville Beach, FL 32250-3264
Phone
(904) 247-3324
Fax
(904) 247-3926
NPI assigned
Jan 8, 2007
Last updated
Jan 24, 2019By the provider in NPPES
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, ATCNPI 1346263969
Title
Administrator
Phone
(904) 858-7045

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Athletic Trainer 2255A2300X AL351 FL
Occupational Therapist 225X00000X NU

Addresses

Primary practice location

1577 Roberts Dr
Suite 320
Jacksonville Beach, FL 32250-3264

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 in27 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

1577 Roberts Dr
Ste 320
Jacksonville Beach, FL 32250
Phone (904) 247-3324

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548288000000",
    "number": "1902954332",
    "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": "1577 ROBERTS DR",
            "address_2": "SUITE 320",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503264",
            "telephone_number": "904-247-3324",
            "fax_number": "904-247-3926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE ORTHOPAEDIC INSTITUTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "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": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL351",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "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 Beach, 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.