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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1821014390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER REHAB MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	PO BOX 96220
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85072-6220
Country	:	US
Telephone Number	:	678-459-3758
Fax Number	:	678-567-6737

Provider Business Practice Location Address
First Line	:	8199 NAVARRE PKWY
Second Line	:	SUITE 12A
City	:	NAVARRE
State	:	FL
Zip	:	32566-6941
Country	:	US
Telephone Number	:	678-932-3629
Fax Number	:	678-932-3629

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	ANNA GAYLORD
Credential	:
Telephone Number	:	678-837-7176

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	01/07/2026

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