Healthcare Provider Details

I. General information

NPI: 1982698510
Provider Name (Legal Business Name): JOHN C FIEGE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 MAYPORT RD
ATLANTIC BEACH FL
32233-3435
US

IV. Provider business mailing address

691 SELVA LAKES CIR
ATLANTIC BEACH FL
32233-7326
US

V. Phone/Fax

Practice location:
  • Phone: 904-349-0990
  • Fax: 904-246-1578
Mailing address:
  • Phone: 904-349-0990
  • Fax: 904-246-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0007180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: