NPIMap

Organization Active NPI

Concierge Physio LLC

  • Physical Therapist
  • Jacksonville Beach, FL
National Provider Identifier
1013559632
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CONCIERGE PHYSIO LLC
Practice address
708 3Rd St N
Jacksonville Beach, FL 32250-7149
Phone
(904) 822-4622
Fax
(904) 201-2595
NPI assigned
Oct 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jonson Yousefzadeh, PT, DPTNPI 1497033633
Title
Owner
Phone
(904) 236-9809

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 224Z00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

708 3Rd St N
Jacksonville Beach, FL 32250-7149

Mailing address

708 3Rd St N
Jacksonville Beach, FL 32250-7149
Phone (904) 822-4622

Other names 1

  • Direct Orthopedic Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191212002095 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4082047667 Receives reassigned benefits from 25 practitioners
Practice locations: Jacksonville Beach, FL

National Provider Directory

National Provider Directory

Locations

710 3rd St N
Jax Bch, FL 32250
Phone (904) 249-1551

708 3rd St N
Jax Bch, FL 32250
Phone (904) 822-4622

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661472000000",
    "number": "1013559632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 3RD ST N",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322507149",
            "telephone_number": "904-822-4622",
            "fax_number": "904-201-2595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 3RD ST N",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322507149",
            "telephone_number": "904-822-4622",
            "fax_number": "904-201-2595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCIERGE PHYSIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-15",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A",
        "authorized_official_last_name": "YOUSEFZADEH",
        "authorized_official_first_name": "JONSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-236-9809",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Direct Orthopedic Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.