Bold City Therapy and Wellness LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PTA23708 Issued in FL

Legal business name

BOLD CITY THERAPY AND WELLNESS LLC

Practice address

1605 King Street
Jacksonville, FL 32204

Phone

(904) 551-0946

Fax

(904) 551-0974

NPI assigned

May 14, 2018

Organization subpart

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Casey Michael McNeill, PTANPI 1366932634

Title

Owner

Phone

(904) 551-0946

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Part of

Bold City Therapy and Wellness LLC

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Griffith, PT

  • Physical Therapist
  • Jacksonville, FL
  • NPI 1649814542
  Medicare reassignment Care Compare group NPD
• Fabian Lopez, PT

  • Physical Therapist
  • Frederick, MD
  • NPI 1326851437

  FL

  Medicare reassignment Care Compare group NPD
• Casey Michael McNeill, PTA

  • Physical Therapy Assistant
  • Jacksonville, FL
  • NPI 1366932634
  NPD Authorized official
• Amanda Chappell

  • Physical Therapist
  • Jacksonville, FL
  • NPI 1013883453
  Care Compare group
• John Joseph Farmer, MT

  • Massage Therapist
  • Jacksonville, FL
  • NPI 1508551151
  NPD
• Michael Jay Bernhardt, MD

  • Dermatology Physician
  • Jacksonville, FL
  • NPI 1386695054
  NPD (past)
• Shanna M Miranti, P.A.

  • Medical Physician Assistant
  • Naples, FL
  • NPI 1265408025
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1427548544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 KING STREET",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32204",
            "telephone_number": "904-551-0946",
            "fax_number": "904-551-0974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 KING STREET",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32204",
            "telephone_number": "904-551-0946",
            "fax_number": "904-551-0974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLD CITY THERAPY AND WELLNESS LLC",
        "organizational_subpart": "YES",
        "enumeration_date": "2018-05-14",
        "last_updated": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "MCNEILL",
        "authorized_official_first_name": "CASEY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-551-0946",
        "authorized_official_credential": "PTA"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "PTA23708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bold City Behavioral Services
• Bold City Chiropractic LLC
• Bold City Doula Coalition
• Bold City Integrative Care
• Bold City Orthotics and Prosthetics, LLC (Bold City Orthotics and Prosthetics)
• Bold Healthcare PLLC
• Tiffany Bolden
• Irina Eugenievna Boldt, M.D.
• Paul R Boldt, D.M.D.
• Lucy Bolerjack, DO

• Physical Therapy Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.