Healthcare Provider Details

I. General information

NPI: 1902167992
Provider Name (Legal Business Name): STEVE FELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 US HIGHWAY 1 S SUITE A
SAINT AUGUSTINE FL
32084-4192
US

IV. Provider business mailing address

1690 US HIGHWAY 1 S SUITE A
SAINT AUGUSTINE FL
32084-4192
US

V. Phone/Fax

Practice location:
  • Phone: 904-180-2101
  • Fax: 904-810-2106
Mailing address:
  • Phone: 904-180-2101
  • Fax: 904-810-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number27325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: