Healthcare Provider Details

I. General information

NPI: 1821014390
Provider Name (Legal Business Name): PREMIER REHAB MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8199 NAVARRE PKWY SUITE 12A
NAVARRE FL
32566-6941
US

IV. Provider business mailing address

PO BOX 96220
PHOENIX AZ
85072-6220
US

V. Phone/Fax

Practice location:
  • Phone: 678-932-3629
  • Fax: 678-932-3629
Mailing address:
  • Phone: 678-459-3758
  • Fax: 678-567-6737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARMEN PHILPOT
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 678-403-3568