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General NPI Number Information
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NPI Number | 1578283453
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Entity Type | Organization
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Legal Business Name | MONTICELLO PHYSICAL THERAPY & WELLNESS
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 195 E DOGWOOD ST
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City | MONTICELLO
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State | FL
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Zip | 32344-1928
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Country | US
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Telephone | 850-321-4443
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Fax | 850-378-4530
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Provider Business Mailing Address
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Address Line | 6492 WAUKEENAH HWY
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City | MONTICELLO
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State | FL
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Zip | 32344-1190
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Country | US
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Telephone | 850-321-4443
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Fax |
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Authorized Official
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Title or Position | MGR, AMBR
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Name | JOHN MARCUS ROBERTS
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Credential | PT, DPT
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Telephone | 850-321-4443
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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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