Healthcare Provider Details

I. General information

NPI: 1932616281
Provider Name (Legal Business Name): RSI PHYSICAL MEDICINE AND PERFORMANCE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 CENTURION PKWY N STE 304
JACKSONVILLE FL
32256-5004
US

IV. Provider business mailing address

10475 CENTURION PKWY N STE 304
JACKSONVILLE FL
32256-5004
US

V. Phone/Fax

Practice location:
  • Phone: 904-270-2673
  • Fax: 904-212-0024
Mailing address:
  • Phone: 904-270-2673
  • Fax: 904-212-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH8750
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN F. FIERRO
Title or Position: OWNER
Credential: DC
Phone: 904-270-2673