Ancient City Children's Therapy, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

12653 Issued in FL

Legal business name

ANCIENT CITY CHILDREN'S THERAPY, LLC

Practice address

367 Gianna Way
St Augustine, FL 32086-3858

Phone

(904) 826-7886

NPI assigned

Apr 12, 2011

Last updated

Apr 12, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Johannie Garcia, OTDNPI 1700184892

Title

Owner

Phone

(904) 826-7886

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Johannie Garcia

  • Specialist
  • St Augustine, FL
  • NPI 1700184892
  NPD (past) Authorized official

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

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302566400000",
    "number": "1619267671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 S. WINTERHAWK,",
            "address_2": "SUITE 7",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "32086",
            "telephone_number": "904-826-7886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 GIANNA WAY",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320863858",
            "telephone_number": "904-826-7886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANCIENT CITY CHILDREN'S THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-12",
        "last_updated": "2011-04-12",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JOHANNIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-826-7886",
        "authorized_official_credential": "OTD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "12653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.