MEDICARE: JOHN C FIEGE 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	PT0007180	FL

General Provider Information

NPI Number	:	1982698510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C FIEGE PT

Provider Business Mailing Address
First Line	:	691 SELVA LAKES CIR
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-7326
Country	:	US
Telephone Number	:	904-349-0990
Fax Number	:	904-246-1578

Provider Business Practice Location Address
First Line	:	1241 MAYPORT RD
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-3435
Country	:	US
Telephone Number	:	904-349-0990
Fax Number	:	904-246-1578

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	03/31/2008

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Directions to “ JOHN C FIEGE PT” Practice Location

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