Professional Physical Therapy and Associates LTD Co
Organization Active NPI Physical Therapist · Edgewater, FL
NPI 1255415550 · NPPES record last updated Sep 23, 2013
Key facts
- NPI
- 1255415550
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 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
- Organization subpart
- No
Authorized official
- Name
- Jeffrey R. Berner, PT, MS
- Title
- Owner, C.E.O.
- Phone
- (386) 423-0100
Practitioners 12
-
Jeffrey R Berner, PT
-
Michelle Lynn Applegate, PPT ATC
-
Jacob Corey Barr, DPT, MTC
-
Katie Carr, DPT
-
Lori Ann Child, OTR
-
Kristen Ann Hanak, P.T.
-
Tammy K Iglehart, PT, ATC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
2568 S Ridgewood Ave
Ste 1
Edgewater, FL 32141
Phone (386) 423-0100
1316 S Ridgewood Ave
Edgewater, FL 32132
Phone (386) 423-0100
1316 S Ridgewood Ave
Ste 1
Edgewater, FL 32132
Phone (386) 423-0100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 887120500 | Medicaid | FL | |
| Y921B | Other | FL | BCBS |
Other providers in Edgewater, FL
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- Jamie Ponti
- Roger Prieto
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- Publix Super Markets Inc
- Pulse Medical Staffing LLC
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- Nancy Carol Purcell
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All providers in Edgewater, FL · Physical Therapist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.