Provider Demographics
NPI:1427269448
Name:YU, JOHN RUSSEL A (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN RUSSEL
Middle Name:A
Last Name:YU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 FOREST MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5619
Mailing Address - Country:US
Mailing Address - Phone:904-314-2128
Mailing Address - Fax:
Practice Address - Street 1:7855 ARGYLE FOREST BLVD STE 504
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-7703
Practice Address - Country:US
Practice Address - Phone:904-573-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist