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General NPI Number Information
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NPI Number | 1205347804
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Entity Type | Organization
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Legal Business Name | PREMIER PHYSICAL THERAPY & SPORTS MEDICINE
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 3660 SW 30TH AVE
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City | PALM CITY
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State | FL
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Zip | 34990-3700
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Country | US
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Telephone | 772-335-7966
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8600
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34985-8600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JEFFREY ALAN TUCKER
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Credential | MPT
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Telephone | 772-335-7966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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