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General NPI Number Information
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NPI Number | 1932616281
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Entity Type | Organization
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Legal Business Name | RSI PHYSICAL MEDICINE AND PERFORMANCE CARE, INC.
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 10475 CENTURION PKWY N STE 304
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5004
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Country | US
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Telephone | 904-270-2673
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Fax | 904-212-0024
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Provider Business Mailing Address
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Address Line | 10475 CENTURION PKWY N STE 304
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5004
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Country | US
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Telephone | 904-270-2673
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Fax | 904-212-0024
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN F. FIERRO
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Credential | DC
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Telephone | 904-270-2673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | CH8750
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License Number State | FL
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