NPIMap

Organization Active NPI

Premier Physical Therapy & Sports Medicine

  • Physical Therapist
  • Melbourne, FL
National Provider Identifier
1669005559
Registry record updated Feb 19, 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
2222 S Harbor City Blvd Ste 530
Melbourne, FL 32901-5591
Phone
(772) 335-7966
NPI assigned
Feb 19, 2020
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
Jeffrey Alan 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: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

2222 S Harbor City Blvd Ste 530
Melbourne, FL 32901-5591

Mailing address

PO Box 8600
Port St Lucie, FL 34985-8600

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.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1669005559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8600",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349858600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 S HARBOR CITY BLVD STE 530",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015591",
            "telephone_number": "772-335-7966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICAL THERAPY & SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "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": "ALAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "772-335-7966",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.