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NPI Code Detail

MEDICARE: PAULO HOMERO SICANGCO PT

MEDICARE:   PAULO HOMERO SICANGCO  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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1376218172
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULO HOMERO SICANGCO PT
Provider Business Mailing Address
First Line : 2950 MONTILLA DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32246-5526
Country : US
Telephone Number : 904-805-3455
Fax Number :
Provider Business Practice Location Address
First Line : 7749 NORMANDY BLVD STE 147
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32221-7658
Country : US
Telephone Number : 904-786-5676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2021
Last Update Date : 08/12/2021

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Directions to “ PAULO HOMERO SICANGCO PT” Practice Location

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