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General NPI Number Information
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NPI Number | 1184153819
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Entity Type | Organization
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Legal Business Name | RIVER CITY PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 11555 CENTRAL PKWY STE 1104
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City | JACKSONVILLE
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State | FL
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Zip | 32224-2703
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Country | US
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Telephone | 904-370-3257
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Fax |
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Provider Business Mailing Address
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Address Line | 11555 CENTRAL PKWY STE 1104
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City | JACKSONVILLE
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State | FL
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Zip | 32224-2703
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Country | US
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Telephone | 904-370-3257
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | NICHOLAS SCOTTO
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Credential | DPT
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Telephone | 904-370-3257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT28507
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License Number State | FL
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