NPIMap

Organization Active NPI

Premier Physical Therapy & Sports Medicine

  • Physical Therapist
  • Jensen Beach, FL
National Provider Identifier
1265724330
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT12440 Issued in FL
Legal business name
PREMIER PHYSICAL THERAPY & SPORTS MEDICINE
Practice address
897 NE Jensen Beach Blvd
Jensen Beach, FL 34957-4799
Phone
(772) 324-3080
Fax
(772) 335-7963
NPI assigned
May 9, 2011
Organization subpart
No

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
Mr. Jeffrey A 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: 193400000X SINGLE SPECIALTY GROUP 225100000X PT12440 FL Primary

Addresses

Primary practice location

897 NE Jensen Beach Blvd
Jensen Beach, FL 34957-4799

Mailing address

897 NE Jensen Beach Blvd
Jensen Beach, FL 34957-4799
Phone (772) 324-3080

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318000876 FL Part B Supplier - Clinic/Group Practice 3173413549 Receives reassigned benefits from 59 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Palm City, FL; West Palm Beach, FL; Vero Beach, FL; Stuart, FL; Port St Lucie, FL; Melbourne, FL; Jensen Beach, FL; Fort Pierce, FL…

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

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

Other organizations with this tax ID 7

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

Locations

2217 S 25th St
Fort Pierce, FL 34947
Phone (772) 464-6424

2214 Bryan St
Melbourne, FL 32901
Phone (321) 312-4200

160 NW Central Park Plz
Ste 108
Port St Lucie, FL 34986
Phone (561) 286-2334

519 NW Lake Whitney Pl
Ste 101
Port St Lucie, FL 34986
Phone (772) 621-9313

5054 SE Federal Hwy
Stuart, FL 34997
Phone (772) 419-7325

2026 SE Ocean Blvd
Stuart, FL 34996
Phone (772) 678-3468

2220 SE Ocean Blvd
Ste 202
Stuart, FL 34996
Phone (772) 283-4713

Practitioners & affiliated clinicians

Practitioners 67

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

View all 67

NPI Registry JSON

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

{
    "created_epoch": "1304899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1265724330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "897 NE JENSEN BEACH BLVD",
            "city": "JENSEN BEACH",
            "state": "FL",
            "postal_code": "349574799",
            "telephone_number": "772-324-3080",
            "fax_number": "772-335-7963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "897 NE JENSEN BEACH BLVD",
            "city": "JENSEN BEACH",
            "state": "FL",
            "postal_code": "349574799",
            "telephone_number": "772-324-3080",
            "fax_number": "772-335-7963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICAL THERAPY & SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-09",
        "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": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "772-335-7966",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT12440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jensen Beach, 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.
  • 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.