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NPI Code Detail

MEDICARE: PVPT, INC.

MEDICARE: PVPT, 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
1261QR0400XRehabilitation Clinic/Center

General Provider Information

NPI Number : 1417992231
Entity Type Code : Organization
Provider Name (Legal Business Name) : PVPT, INC.
Provider Business Mailing Address
First Line : PO BOX 48116
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32247-8116
Country : US
Telephone Number : 904-725-1657
Fax Number : 904-725-7247
Provider Business Practice Location Address
First Line : 880 A1A N
Second Line : STE 18A
City : PONTE VEDRA BEACH
State : FL
Zip : 32082-3220
Country : US
Telephone Number : 904-285-2910
Fax Number : 904-285-4663
Authorized Official
Title or Position : VICE PRESIDENT
Name : JEFFREY C PARKS
Credential :
Telephone Number : 904-725-1657
Provider Enumeration Date : 06/17/2006
Last Update Date : 08/31/2007

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