Healthcare Provider Details

I. General information

NPI: 1487088837
Provider Name (Legal Business Name): PREMIER REHAB MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 MARINA DR SUITE 302
PORT ST JOE FL
32456-1832
US

IV. Provider business mailing address

PO BOX 242037
MONTGOMERY AL
36124-2037
US

V. Phone/Fax

Practice location:
  • Phone: 866-464-3878
  • Fax: 334-396-4905
Mailing address:
  • Phone: 334-396-3273
  • Fax: 334-396-4905

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