Provider Demographics
NPI:1326792599
Name:DORSETT, EMMA (PT, DPT)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:DORSETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 HIDDEN COVE CIR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32233-6917
Mailing Address - Country:US
Mailing Address - Phone:904-571-8520
Mailing Address - Fax:
Practice Address - Street 1:100 EXECUTIVE WAY STE 109
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-2713
Practice Address - Country:US
Practice Address - Phone:904-543-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist