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General NPI Number Information
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NPI Number | 1255415550
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHYSICAL THERAPY AND ASSOCIATES LTD CO
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 1316 S. RIDGEWOOD AVENUE SUITE 1
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City | EDGEWATER
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State | FL
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Zip | 32132
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Country | US
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Telephone | 386-423-0100
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Fax | 386-428-8631
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Provider Business Mailing Address
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Address Line | 1316 S. RIDGEWOOD AVENUE SUITE 1
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City | EDGEWATER
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State | FL
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Zip | 32132
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Country | US
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Telephone | 386-423-0100
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Fax | 386-428-8631
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Authorized Official
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Title or Position | OWNER, C.E.O.
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Name | JEFFREY R. BERNER
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Credential | PT, MS
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Telephone | 386-423-0100
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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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