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NPI Code Detail

MEDICARE: PETER A CONRIQUE

MEDICARE: PETER A CONRIQUE
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
12255A2300XAthletic Trainer
2225100000XPhysical TherapistPT25868FL

General Provider Information

NPI Number : 1720198435
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER A CONRIQUE
Provider Business Mailing Address
First Line : 55801 BEAR RUN RD
Second Line :
City : CALLAHAN
State : FL
Zip : 32011-8514
Country : US
Telephone Number : 904-879-9576
Fax Number :
Provider Business Practice Location Address
First Line : 12961 N MAIN ST
Second Line : SUITE 201 & 202
City : JACKSONVILLE
State : FL
Zip : 32218-2769
Country : US
Telephone Number : 904-757-2474
Fax Number : 904-757-5541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 09/14/2010

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Directions to “ PETER A CONRIQUE ” Practice Location

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