Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Innovative Physiatry Spine Clinic, LLC

Organization Pain Medicine (Physical Medicine & Rehabilitation) Physician · NPI 1487175881

Innovative Physiatry Spine Clinic, LLC is a Pain Medicine (Physical Medicine & Rehabilitation) Physician in St Johns, Florida. Licensed in Florida. Registered with an NPI since 2017.

Licensed in
FL
In the registry since
2017
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

165 Durbin Station Ct Ste 601
St Johns, FL 32259-9370
Phone: (904) 671-0288
Fax: (904) 508-0674
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pain Medicine (Physical Medicine & Rehabilitation) Physician (primary) Taxonomy 2081P2900X · Licence OS12124 (FL)

Record details

NPI number1487175881
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Seck Lim — Practice Administrator · (904) 671-0288
NPI enumeratedJuly 6, 2017
Last updated in NPPESSeptember 2, 2021
Certification dateSeptember 2, 2021
Mailing addressPo Box 385, Ponte Vedra Beach, FL 32004-0385