Active NPI
Jenivieve Janet Prezas, DPT
- Physical Therapist
- West Melbourne, FL
National Provider Identifier
1669070884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT30372
- Practice address
- 4311 Norfolk Pkwy Ste 116
West Melbourne, FL 32904-8617 - Phone
- (321) 802-5816
- Fax
- (321) 802-5811
- NPI assigned
- Oct 9, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT30372 | FL | Primary |
Addresses
Primary practice location
4311 Norfolk Pkwy Ste 116
West Melbourne, FL 32904-8617
Mailing address
709 S Harbor City Blvd Ste 100
Melbourne, FL 32901-1936
Phone (321) 722-7225
Other practice location 1
709 S Harbor City Blvd Ste 100
Melbourne, FL 32901-1936
Phone (321) 802-5810
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT30372 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622505600000",
"number": "1669070884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 S HARBOR CITY BLVD STE 100",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329011936",
"telephone_number": "321-722-7225",
"fax_number": "321-308-0635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4311 NORFOLK PKWY STE 116",
"city": "WEST MELBOURNE",
"state": "FL",
"postal_code": "329048617",
"telephone_number": "321-802-5816",
"fax_number": "321-802-5811"
}
],
"practiceLocations": [
{
"address_1": "709 S Harbor City Blvd Ste 100",
"address_purpose": "LOCATION",
"city": "Melbourne",
"state": "FL",
"postal_code": "329011936",
"country_code": "US",
"telephone_number": "321-802-5810",
"fax_number": "321-802-5811",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PREZAS",
"first_name": "JENIVIEVE",
"middle_name": "JANET",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-09",
"last_updated": "2021-06-01",
"certification_date": "2021-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT30372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Melbourne, FL
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- Dianna Linda Apostol Puchero, OTR/L
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.