Provider Demographics
NPI:1073261897
Name:PREVAIL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:PREVAIL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSCIAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TORI
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-208-8811
Mailing Address - Street 1:22 BERMUDA GREENS AVE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-4370
Mailing Address - Country:US
Mailing Address - Phone:904-208-8811
Mailing Address - Fax:904-814-8953
Practice Address - Street 1:22 BERMUDA GREENS AVE
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-4370
Practice Address - Country:US
Practice Address - Phone:904-208-8811
Practice Address - Fax:904-814-8953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty