NPIMap

Organization Active NPI

Premier Physical Therapy and Rehabilitation of Jacksonville, Inc

  • Physical Therapist
  • Ponte Vedra Beach, FL
National Provider Identifier
1821855586
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PREMIER PHYSICAL THERAPY AND REHABILITATION OF JACKSONVILLE, INC
Practice address
6 Fairfield Blvd Ste 6
Ponte Vedra Beach, FL 32082-4628
Phone
(904) 996-6922
NPI assigned
Feb 29, 2024
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
Christopher Karl KoppNPI 1437321767
Title
Owner
Phone
(904) 996-6922

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: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

6 Fairfield Blvd Ste 6
Ponte Vedra Beach, FL 32082-4628

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Premier Physical Therapy and Rehabilitation of Jacksonville Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

6 Fairfield Blvd
Ste 6
Ponte Vedra Beach, FL 32082
Phone (904) 373-0904

Practitioners & affiliated clinicians

Practitioners 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1821855586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 PABLO PROFESSIONAL CT # 155",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322243219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 FAIRFIELD BLVD STE 6",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824628",
            "telephone_number": "904-996-6922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICAL THERAPY AND REHABILITATION OF JACKSONVILLE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "KOPP",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "KARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-996-6922"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

Verify at the official NPI Registry.