Provider Demographics
NPI:1275057689
Name:PRENGLE, ROBERT HAMILTON (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HAMILTON
Last Name:PRENGLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:
Other - Last Name:PRENGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3901 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4312
Mailing Address - Country:US
Mailing Address - Phone:904-345-7336
Mailing Address - Fax:
Practice Address - Street 1:10423 CENTURION PKWY N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0527
Practice Address - Country:US
Practice Address - Phone:904-854-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT32681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist