Healthcare Provider Details

I. General information

NPI: 1871695585
Provider Name (Legal Business Name): BRETT RICHARD JORGENSON MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 PONTE VEDRA PARK DRIVE SUITE 300
PONTE VEDRA BEACH FL
32082
US

IV. Provider business mailing address

8971 HAMPTON LANDING DR E
JACKSONVILLE FL
32256-4585
US

V. Phone/Fax

Practice location:
  • Phone: 904-280-3440
  • Fax: 904-280-3444
Mailing address:
  • Phone: 904-519-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT018040
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT018040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: