Healthcare Provider Details

I. General information

NPI: 1386173656
Provider Name (Legal Business Name): PREMIER MEDICAL REHAB GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 ARMSDALE RD
JACKSONVILLE FL
32218-3311
US

IV. Provider business mailing address

12864 BISCAYNE BLVD # 442
NORTH MIAMI FL
33181-2007
US

V. Phone/Fax

Practice location:
  • Phone: 904-714-3793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORDAN KLEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 717-712-3617