Provider Demographics
NPI:1184153819
Name:RIVER CITY PHYSICAL THERAPY
Entity type:Organization
Organization Name:RIVER CITY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:904-370-3257
Mailing Address - Street 1:11555 CENTRAL PKWY STE 1104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2703
Mailing Address - Country:US
Mailing Address - Phone:904-370-3257
Mailing Address - Fax:
Practice Address - Street 1:11555 CENTRAL PKWY STE 1104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2703
Practice Address - Country:US
Practice Address - Phone:904-370-3257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty