Healthcare Provider Details

I. General information

NPI: 1700219599
Provider Name (Legal Business Name): PREMIER REHAB MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 PANAMA CITY BEACH PKWY SUITE A
PANAMA CITY BEACH FL
32413-5301
US

IV. Provider business mailing address

PO BOX 441146
KENNESAW GA
30160-9522
US

V. Phone/Fax

Practice location:
  • Phone: 678-932-3629
  • Fax: 770-423-3369
Mailing address:
  • Phone: 770-917-1395
  • Fax: 770-423-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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