MEDICARE: JUSTIN C DELICATO PTA

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
1	225200000X	Physical Therapy Assistant	PTA24306	FL

General Provider Information

NPI Number	:	1922430891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN C DELICATO PTA

Provider Business Mailing Address
First Line	:	1325 SAN MARCO BLVD
Second Line	:	SUITE 102
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8568
Country	:	US
Telephone Number	:	904-858-7045
Fax Number	:	904-858-7047

Provider Business Practice Location Address
First Line	:	1845 TOWN CENTER BLVD
Second Line	:	SUITE 410
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-3356
Country	:	US
Telephone Number	:	904-621-0396
Fax Number	:	904-621-0397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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Directions to “ JUSTIN C DELICATO PTA” Practice Location

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