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NPI Code Detail

MEDICARE: BOLD CITY THERAPY AND WELLNESS LLC

MEDICARE: BOLD CITY THERAPY AND WELLNESS LLC
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
1261QP2000XPhysical Therapy Clinic/CenterPTA23708FL

General Provider Information

NPI Number : 1427548544
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOLD CITY THERAPY AND WELLNESS LLC
Provider Business Mailing Address
First Line : 1605 KING STREET
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204
Country : US
Telephone Number : 904-551-0946
Fax Number : 904-551-0974
Provider Business Practice Location Address
First Line : 1605 KING STREET
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204
Country : US
Telephone Number : 904-551-0946
Fax Number : 904-551-0974
Authorized Official
Title or Position : OWNER
Name : CASEY MICHAEL MCNEILL
Credential : PTA
Telephone Number : 904-551-0946
Provider Enumeration Date : 05/14/2018
Last Update Date : 10/02/2023

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Directions to “BOLD CITY THERAPY AND WELLNESS LLC ” Practice Location

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