Healthcare Provider Details

I. General information

NPI: 1477413581
Provider Name (Legal Business Name): NICHOLAS CALABRO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ASHOURIAN AVE STE 105
ST AUGUSTINE FL
32092-5106
US

IV. Provider business mailing address

3901 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4312
US

V. Phone/Fax

Practice location:
  • Phone: 904-230-7761
  • Fax:
Mailing address:
  • Phone: 904-345-7251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number43837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: