NPIMap

Organization Active NPI

Premier Physical Therapy & Sports Medicine

  • Physical Therapist
  • Port Saint Lucie, FL
National Provider Identifier
1386274504
Registry record updated Jan 16, 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
4007 SW Port St Lucie Blvd Ste 6
Port Saint Lucie, FL 34953-5679
Phone
(772) 335-7966
NPI assigned
Jan 16, 2020
Last updated
Jan 16, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PREMIER PHYSICAL THERAPY & SPORTS MEDICINEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 16, 2020

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

Authorized official

Name
Jeffrey Alan TuckerNPI 1982725230
Title
Owner
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 Therapist 225100000X NU Primary

Addresses

Primary practice location

4007 SW Port St Lucie Blvd Ste 6
Port Saint Lucie, FL 34953-5679

Mailing address

PO Box 8600
Port Saint Lucie, FL 34985-8600

National Provider Directory

National Provider Directory
Tax ID family
Premier Physical Therapy Sports Medicine8 organizations share this tax ID, including this one
Part of
Premier Physical Therapy Sports Medicine

Other organizations with this tax ID 7

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

Locations

4007 SW Port St Lucie Blvd
Ste 6
Port St Lucie, FL 34953
Phone (772) 281-4722

Practitioners & affiliated clinicians

Practitioners 1

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": "1579132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579132800000",
    "number": "1386274504",
    "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": "4007 SW PORT ST LUCIE BLVD STE 6",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349535679",
            "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": "2020-01-16",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-335-7966"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.