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

Emil Mitchell Azzam, DPT

Individual provider Athletic Trainer · NPI 1871067884

Emil Mitchell Azzam, DPT is a Physical Therapist in Private Practice in Jacksonville, Florida. Qualified in 2024, 2 years ago. Practices with Southeast Orthopedic Specialists LLC, a 145-clinician group, works from 6 locations and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
2
Licensed in
FL
In the registry since
2019
Specialties on file
2
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

2627 Riverside Ave Ste 300
Jacksonville, FL 32204-4717
Phone: (904) 634-0640
Fax: (904) 634-0203
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (5)

  • 4268 Oldfield Crossing Dr Ste 201, Jacksonville, FL 32223-8800 — (904) 634-0640
  • 10475 Centurion Pkwy N Ste 220, Jacksonville, FL 32256-5004 — (904) 634-0640
  • 2300 Park Ave Ste 206, Orange Park, FL 32073-5573 — (904) 634-0640
  • 232 Ponte Vedra Park Dr, Ponte Vedra Beach, FL 32082-6600 — (904) 634-0640
  • 1690 Us Highway 1 S Ste F, St Augustine, FL 32084-6024 — (904) 634-0640

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT42105 (FL)
Athletic Trainer Taxonomy 2255A2300X

Record details

NPI number1871067884
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedJanuary 14, 2019
Last updated in NPPESMay 13, 2025
Certification dateMay 13, 2025
Mailing address6800 Southpoint Pkwy Ste 300, Jacksonville, FL 32216-8203

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Southeast Orthopedic Specialists Llc — 145 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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