NPIMap

Organization Active NPI

Professional Physical Therapy and Associates LTD Co

  • Physical Therapist
  • Edgewater, FL
National Provider Identifier
1255415550
Registry record updated Sep 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROFESSIONAL PHYSICAL THERAPY AND ASSOCIATES LTD CO
Practice address
1316 S. Ridgewood Avenue
Suite 1
Edgewater, FL 32132
Phone
(386) 423-0100
Fax
(386) 428-8631
NPI assigned
Oct 24, 2006
Last updated
Sep 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2013

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

Authorized official

Name
Jeffrey R. Berner, PT, MSNPI 1275643397
Title
Owner, C.E.O.
Phone
(386) 423-0100

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 Therapist 225100000X Primary

Addresses

Primary practice location

1316 S. Ridgewood Avenue
Suite 1
Edgewater, FL 32132

Mailing address

1316 S. Ridgewood Avenue
Suite 1
Edgewater, FL 32132
Phone (386) 423-0100

Other identifiers 2

IdentifierTypeStateIssuer
887120500MedicaidFL
Y921BOtherFLBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031211000864 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4688570328 Receives reassigned benefits from 4 practitioners
Practice locations: Edgewater, FL; New Smyrna Beach, FL

National Provider Directory

National Provider Directory

Locations

1316 S Ridgewood Ave
Edgewater, FL 32132
Phone (386) 423-0100

1316 S Ridgewood Ave
Ste 1
Edgewater, FL 32132
Phone (386) 423-0100

2568 S Ridgewood Ave
Ste 1
Edgewater, FL 32141
Phone (386) 423-0100

Practitioners & affiliated clinicians

Practitioners 12

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": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1255415550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1316 S. RIDGEWOOD AVENUE",
            "address_2": "SUITE 1",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "32132",
            "telephone_number": "386-423-0100",
            "fax_number": "386-428-8631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1316 S. RIDGEWOOD AVENUE",
            "address_2": "SUITE 1",
            "city": "EDGEWATER",
            "state": "FL",
            "postal_code": "32132",
            "telephone_number": "386-423-0100",
            "fax_number": "386-428-8631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PHYSICAL THERAPY AND ASSOCIATES LTD CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "BERNER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER, C.E.O.",
        "authorized_official_telephone_number": "386-423-0100",
        "authorized_official_credential": "PT, MS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "887120500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y921B",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; 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.