Provider Demographics
NPI:1255508008
Name:SMART BODY PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:SMART BODY PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-382-3804
Mailing Address - Street 1:11555 CENTRAL PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2693
Mailing Address - Country:US
Mailing Address - Phone:904-296-4140
Mailing Address - Fax:904-279-0963
Practice Address - Street 1:11555 CENTRAL PKWY STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2693
Practice Address - Country:US
Practice Address - Phone:904-296-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy