MEDICARE: SHELLY FRECHETTE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	9658	FL

General Provider Information

NPI Number	:	1245700939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY FRECHETTE PT

Provider Business Mailing Address
First Line	:	537 CARAWAY CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-4494
Country	:	US
Telephone Number	:	904-742-5112
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 PLANTATION ISLAND DR S
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080-6191
Country	:	US
Telephone Number	:	904-742-5112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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