PROVIDIAN FUNCTIONAL CAPACITY SPECIALISTS
Physical Therapy at Orange Ave, Green Cove Springs, FL

License number
Florida AL1714
Category
Ambulatory Health
Type
Physical Therapy
Owner
Name: MR. BRIAN SCOTT IMLER BA, A.T.,C/L
Title: PRESIDENT
Phone: (904) 982-5762
Address
Address
716 N Orange Ave, Green Cove Springs, FL 32043
National Provider ID: 1013258862
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Providian Functional Capacity Specialists, LLC

Orange Park, FL  -  Green Cove Springs, FL  -  Jacksonville, FL

Industry:
Nonclassifiable Establishments
Registration:
Jan 23, 2004
Addresses:
PO Box 9539, Orange Park, FL 32006
716 N Orange Ave, Green Cove Springs, FL 32043
7785 Baymeadows Way, Jacksonville, FL 32256
3675 Winged Foot Cir, Green Cove Springs, FL 32043
State ID:
L04000006169
Business type:
Florida Limited Liability
Managing Members:
Align Networks Sub Inc (Managing Member),Brian Imler Managing Member, inactive
Agent:
Corporate Creations Network,Inc

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