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General NPI Number Information
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NPI Number | 1346963105
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Entity Type | Organization
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Legal Business Name | ANCIENT CITY MOBILE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 164 SPANISH MARSH DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32095-7405
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Country | US
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Telephone | 443-983-4627
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Fax |
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Provider Business Mailing Address
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Address Line | 164 SPANISH MARSH DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32095-7405
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Country | US
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Telephone | 443-983-4627
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. MARGO SLOVIS
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Credential | PT, DPT
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Telephone | 443-983-4627
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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 |
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License Number State |
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