NPIMap

Organization Active NPI

Premier Physical Therapy & Sports Medicine

  • Physical Therapist
  • Palm City, FL
National Provider Identifier
1205347804
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PREMIER PHYSICAL THERAPY & SPORTS MEDICINE
Practice address
3660 SW 30TH Ave
Palm City, FL 34990-3700
Phone
(772) 335-7966
NPI assigned
Oct 23, 2017
Organization subpart
Yes
Parent organization
PREMIER PHYSICAL THERAPY & SPORTS MEDICINEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Jeffrey Alan Tucker, MPTNPI 1982725230
Title
Executive Director
Phone
(772) 335-7966

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

3660 SW 30TH Ave
Palm City, FL 34990-3700

Mailing address

PO Box 8600
Port Saint Lucie, FL 34985-8600

National Provider Directory

National Provider Directory
Tax ID family
Premier Physical Therapy Sport Medicine Inc8 organizations share this tax ID, including this one
Part of
Premier Physical Therapy Sport Medicine Inc

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3660 SW 30th Ave
Palm City, FL 34990
Phone (772) 291-2261

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1205347804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8600",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349858600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3660 SW 30TH AVE",
            "city": "PALM CITY",
            "state": "FL",
            "postal_code": "349903700",
            "telephone_number": "772-335-7966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICAL THERAPY & SPORTS MEDICINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER PHYSICAL THERAPY & SPORTS MEDICINE",
        "enumeration_date": "2017-10-23",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "772-335-7966",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.