Provider Demographics
NPI:1962079467
Name:COLTMAN AND BAUGHMAN PHYSICAL THERAPY PA
Entity type:Organization
Organization Name:COLTMAN AND BAUGHMAN PHYSICAL THERAPY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BAUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC, OCS
Authorized Official - Phone:904-853-5106
Mailing Address - Street 1:350 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5024
Mailing Address - Country:US
Mailing Address - Phone:904-853-5106
Mailing Address - Fax:904-853-5107
Practice Address - Street 1:14797 PHILIPS HWY # 205
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3746
Practice Address - Country:US
Practice Address - Phone:904-853-5106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy