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NPI Code Detail

MEDICARE: MRS. JEANETTE MICELOTTA PT

MEDICARE: MRS. JEANETTE MICELOTTA PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT11125FL

General Provider Information

NPI Number : 1497781132
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEANETTE MICELOTTA PT
Provider Business Mailing Address
First Line : 12421 SAN JOSE BLVD
Second Line : SUITE 100
City : JACKSONVILLE
State : FL
Zip : 32223-2680
Country : US
Telephone Number : 904-292-0195
Fax Number : 904-292-0566
Provider Business Practice Location Address
First Line : 12421 SAN JOSE BLVD
Second Line : SUITE 100
City : JACKSONVILLE
State : FL
Zip : 32223-2680
Country : US
Telephone Number : 904-292-0195
Fax Number : 904-292-0566
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. JEANETTE MICELOTTA PT” Practice Location

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