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General NPI Number Information
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NPI Number | 1700230620
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Entity Type | Organization
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Legal Business Name | CONCIERGE PHYSICAL THERAPY SERVICES PLLC
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Dates
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Enumeration Date | 04/17/2016
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 3103 MANATEE AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-3350
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Country | US
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Telephone | 941-447-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 TERRA CEIA BAY BLVD #1702
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City | PALMETTO
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State | FL
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Zip | 34221-5989
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Country | US
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Telephone | 941-447-8040
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOCELYN PUNG
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Credential | PHYSICAL THERAPIST
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Telephone | 941-447-8040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT11720
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License Number State | FL
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