MEDICARE: JG PHYSICAL THERAPY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013426519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JG PHYSICAL THERAPY CORP

Provider Business Mailing Address
First Line	:	1348 SE 17TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1708
Country	:	US
Telephone Number	:	954-530-8289
Fax Number	:	754-301-7942

Provider Business Practice Location Address
First Line	:	1348 SE 17TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1708
Country	:	US
Telephone Number	:	954-530-8289
Fax Number	:	754-301-7942

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JASON GOLDNER
Credential	:
Telephone Number	:	954-530-8289

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	07/21/2022

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Directions to “JG PHYSICAL THERAPY CORP ” Practice Location

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