Provider Demographics
NPI:1902537160
Name:DAWSON, MARILYN (PT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 PERREGRINE CIR E
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2966
Mailing Address - Country:US
Mailing Address - Phone:904-417-5393
Mailing Address - Fax:
Practice Address - Street 1:9601 SOUTHBROOK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0601
Practice Address - Country:US
Practice Address - Phone:904-641-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist