Provider Demographics
NPI:1326035924
Name:CPT OF JACKSONVILLE INC
Entity Type:Organization
Organization Name:CPT OF JACKSONVILLE INC
Other - Org Name:CENTER FOR PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-733-8133
Mailing Address - Street 1:3716 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4355
Mailing Address - Country:US
Mailing Address - Phone:904-733-8133
Mailing Address - Fax:
Practice Address - Street 1:3716 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4355
Practice Address - Country:US
Practice Address - Phone:904-733-8133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ 34OtherBLUE CROSS BLUE SHIELD ID
FLQ 34OtherBLUE CROSS BLUE SHIELD ID