MEDICARE: PATRICK PICARD

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	225200000X	Physical Therapy Assistant	09485	OR
2	225200000X	Physical Therapy Assistant	6281	NC
3	225200000X	Physical Therapy Assistant	2129076	TX
4	225200000X	Physical Therapy Assistant	27522	FL

General Provider Information

NPI Number	:	1730609801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK PICARD

Provider Business Mailing Address
First Line	:	11123 RIVER CREEK DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-7285
Country	:	US
Telephone Number	:	813-352-3718
Fax Number	:

Provider Business Practice Location Address
First Line	:	11123 RIVER CREEK DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-7285
Country	:	US
Telephone Number	:	813-352-3718
Fax Number	:

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

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	07/21/2022

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Directions to “ PATRICK PICARD ” Practice Location

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