MEDICARE: PREMIER REHAB MANAGEMENT, LLC

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

General Provider Information

NPI Number	:	1700219599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER REHAB MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	PO BOX 441146
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30160-9522
Country	:	US
Telephone Number	:	770-917-1395
Fax Number	:	770-423-3369

Provider Business Practice Location Address
First Line	:	16201 PANAMA CITY BEACH PKWY
Second Line	:	SUITE A
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-5301
Country	:	US
Telephone Number	:	678-932-3629
Fax Number	:	770-423-3369

Authorized Official
Title or Position	:	DIRECTOR REVENUE CYCLE
Name	:	CARMEN PHILPOT
Credential	:
Telephone Number	:	678-403-3568

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	08/16/2019

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