Justin Podell, PT, DPT, MED, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

30375 Issued in FL

Practice address

10423 Centurion Pkwy N
Jacksonville, FL 32256-0527

Phone

(904) 854-2090

Fax

(904) 854-2093

NPI assigned

Aug 24, 2015

Last updated

Aug 24, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Resurgent Sports Rehab LLCGroup PAC ID 5193157154, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Resurgent Sports Rehab LLC

  • Physical Therapy Clinic/Center
  • Fairfax, VA
  • NPI 1932753811

  DC, Physical Therapist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1440374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440374400000",
    "number": "1558738773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10423 CENTURION PKWY N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560527",
            "telephone_number": "904-854-2090",
            "fax_number": "904-854-2093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10423 CENTURION PKWY N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560527",
            "telephone_number": "904-854-2090",
            "fax_number": "904-854-2093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PODELL",
        "first_name": "JUSTIN",
        "credential": "PT, DPT, MED, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-24",
        "last_updated": "2015-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "30375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Plut, AP
• Plymouth Home for Adults, Inc.
• Saw Francis PO, MD
• Charles A. Poblenz, DMD
• Theresa Garcia Poblete, PT
• Podiatrist on Call, LLC
• Podiatry Associates of Florida Inc
• Podiatry Associates of Florida Inc
• Podiatry Associates of Florida Inc
• Podiatry Associates of Florida Inc

• Physical Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.