Jennifer Taylor
Individual provider Active NPI Physical Therapist · Mims, FL
NPI 1295110583 · NPPES record last updated Jul 28, 2015
Key facts
- NPI
- 1295110583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT27542 (FL)
- Practice address
- 3218 Legacy Dr
Mims, FL 32754-3022 - Phone
- (888) 265-2680
- NPI assigned
- Jul 28, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Space Coast Lymphedema Clinic LLC
Practice addresses (Care Compare)
7000 Spyglass CT
Suite 120
Viera, FL 32940-7948
Phone (321) 241-6543
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260114000467 | FL | Practitioner - Physical Therapist in Private Practice | 4789160367 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT27542 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Space Coast Lymphedema Clinic LLC | Physical Therapist | Current |
Accepting new patients |
Locations
7000 Spyglass Ct
Ste 120
Viera, FL 32940
Phone (321) 241-6543
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT27542 | FL | Yes |
Addresses
Primary practice location
3218 Legacy Dr
Mims, FL 32754-3022
Mailing address
3218 Legacy Dr
Mims, FL 32754-3022
Other providers in Mims, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2015. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.