Individual
ALLAN M FIESTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
5393 ROOSEVELT BLVD STE 17, CREDENTIALING DEPARTMENT, JACKSONVILLE, FL 32210-8424
(904) 389-8570
(904) 389-8599
Mailing address
PO BOX 40767, CREDENTIALING DEPARTMENT, JACKSONVILLE, FL 32203-0767
(904) 376-3707
(904) 391-5807
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT009552
GA
225100000X
Physical Therapist
Primary
PT24647
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01226234
RR MEDICARE
FL
Enumeration date
07/01/2013
Last updated
02/04/2015
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