NPIMap

Organization Active NPI

Premier Physical Therapy and Rehabilitation of Jacksonville, Inc.

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1467594358
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT13725 Issued in FL
Legal business name
PREMIER PHYSICAL THERAPY AND REHABILITATION OF JACKSONVILLE, INC.
Practice address
4320 Pablo Professional CT # 155
Jacksonville, FL 32224-3219
Phone
(904) 996-6922
Fax
(904) 996-6923
NPI assigned
Feb 14, 2007
Last updated
Feb 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Mrs. Chris M. Kopp
Title
Owner
Phone
(904) 996-6922

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT13725 FL Primary
Physical Therapy Clinic/Center 261QP2000X FL

Addresses

Primary practice location

4320 Pablo Professional CT # 155
Jacksonville, FL 32224-3219

Mailing address

13947 Beach Blvd #109
Jacksonville, FL 32224-1201
Phone (904) 996-6922

Other names 1

  • Premier P.T. Marketing Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060503000568 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2264442318 Receives reassigned benefits from 14 practitioners
Practice locations: Jacksonville, FL; Ponte Vedra Beach, FL

National Provider Directory

National Provider Directory

Locations

13947 Beach Blvd
Ste 109
Jacksonville, FL 32224
Phone (561) 319-6984

4230 Pablo Professional Ct
Ste 155
Jacksonville, FL 32224

4320 Pablo Professional Ct
#155
Jacksonville, FL 32224

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1467594358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13947 BEACH BLVD #109",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241201",
            "telephone_number": "904-996-6922",
            "fax_number": "904-996-6923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 PABLO PROFESSIONAL CT # 155",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322243219",
            "telephone_number": "904-996-6922",
            "fax_number": "904-996-6923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICAL THERAPY AND REHABILITATION OF JACKSONVILLE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "KOPP",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-996-6922",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT13725",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier P.T. Marketing",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; 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.