Provider Demographics
NPI:1174245716
Name:SB PHYSICAL THERAPY AND WELLNESS, LLC
Entity type:Organization
Organization Name:SB PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:904-655-9094
Mailing Address - Street 1:830 A1A N STE 13
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3290
Mailing Address - Country:US
Mailing Address - Phone:904-655-9094
Mailing Address - Fax:
Practice Address - Street 1:179 SOLANO CAY CIR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-2246
Practice Address - Country:US
Practice Address - Phone:904-655-9094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy