MEDICARE: CPT OF JACKSONVILLE INC

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	261QP2000X	Physical Therapy Clinic/Center		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q 34	OTHER	FL	BLUE CROSS BLUE SHIELD ID

General Provider Information

NPI Number	:	1326035924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CPT OF JACKSONVILLE INC

Provider Business Mailing Address
First Line	:	3716 UNIVERSITY BLVD S
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4355
Country	:	US
Telephone Number	:	904-733-8133
Fax Number	:

Provider Business Practice Location Address
First Line	:	3716 UNIVERSITY BLVD S
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4355
Country	:	US
Telephone Number	:	904-733-8133
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. SAM ROGOZINSKI
Credential	:
Telephone Number	:	904-733-8133

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	11/19/2008

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Directions to “CPT OF JACKSONVILLE INC ” Practice Location

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