NPIMap

Organization Active NPI

Ponte Vedra Physical Therapy, Inc.

  • Rehabilitation Clinic/Center
  • Ponte Vedra Beach, FL
National Provider Identifier
1043246580
Registry record updated Dec 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PONTE VEDRA PHYSICAL THERAPY, INC.
Practice address
880 A1A N
Suite 18a
Ponte Vedra Beach, FL 32082-3221
Phone
(904) 285-2910
Fax
(904) 285-4663
NPI assigned
Jun 25, 2006
Last updated
Dec 7, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2007

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

Authorized official

Name
Mr. Jeffrey C Parks
Title
President
Phone
(904) 285-2910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NU Primary

Addresses

Primary practice location

880 A1A N
Suite 18a
Ponte Vedra Beach, FL 32082-3221

Mailing address

PO Box 48116
Jacksonville, FL 32247-8116
Phone (904) 725-1657

Other identifiers 1

IdentifierTypeStateIssuer
R9FOtherFLBCBS

National Provider Directory

National Provider Directory

Locations

880 A1A N
Ste 18A
Ponte Vedra Beach, FL 32082
Phone (904) 285-2910

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196985600000",
    "number": "1043246580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 48116",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322478116",
            "telephone_number": "904-725-1657",
            "fax_number": "904-725-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 A1A N",
            "address_2": "SUITE 18A",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823221",
            "telephone_number": "904-285-2910",
            "fax_number": "904-285-4663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONTE VEDRA PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2007-12-07",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-285-2910",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "R9F",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.