Judo Ryu Jacksonville, Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT7180 Issued in FL

Legal business name

JUDO RYU JACKSONVILLE, INC

Doing business as

Gentle Way Physical Therapy

Practice address

1241 Mayport Rd
Atlantic Beach, FL 32233-3435

Phone

(904) 349-0990

Fax

(866) 737-1635

NPI assigned

Oct 19, 2007

Last updated

Apr 20, 2008By 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

Susan Manchester

Title

Billing Agent

Phone

(904) 777-5002

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gentle Way Physical Therapy Doing business as

Locations

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.

• John C Fiege, PT

  • Physical Therapist
  • Atlantic Beach, FL
  • NPI 1982698510
  NPD (past)

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

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1982893509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "691 SELVA LAKES CIR",
            "city": "ATLANTIC BEACH",
            "state": "FL",
            "postal_code": "322337326",
            "telephone_number": "904-349-0990",
            "fax_number": "866-737-1635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 MAYPORT RD",
            "city": "ATLANTIC BEACH",
            "state": "FL",
            "postal_code": "322333435",
            "telephone_number": "904-349-0990",
            "fax_number": "866-737-1635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUDO RYU JACKSONVILLE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-19",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MANCHESTER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "BILLING AGENT",
        "authorized_official_telephone_number": "904-777-5002"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT7180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF FLORIDA",
            "identifier": "Y4214",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gentle Way Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sierra Dawn James, RD, LDN
• Jax RX Inc
• Jjamm2 LLC
• Christopher Dane Johnson, DC
• Michelle Monet Degen Johnson, CCC-SLP
• Karing for Little Hands, Inc
• Mary Lois Keezel, DMD
• Alyssa Smith Keimig, D.C.
• Francesca Kiel
• Julian Christian Kinnaird

• Physical Therapist in Atlantic Beach, FL
• Providers in Atlantic Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.