Provider Demographics
NPI:1275643397
Name:BERNER, JEFFREY R (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:BERNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 S RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-2718
Mailing Address - Country:US
Mailing Address - Phone:386-423-0100
Mailing Address - Fax:386-428-8631
Practice Address - Street 1:2568 S RIDGEWOOD AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-7535
Practice Address - Country:US
Practice Address - Phone:386-423-0100
Practice Address - Fax:386-428-8631
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
660020510OtherTRAVELERS RAILROAD MEDICA
FLY9686OtherBLUE CROSS
FL887280500Medicaid
FLE3225YMedicare ID - Type Unspecified