Provider Demographics
NPI:1568533271
Name:PENEMARIE K MURPHY INC
Entity Type:Organization
Organization Name:PENEMARIE K MURPHY INC
Other - Org Name:PHYSICAL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENEMARIE
Authorized Official - Middle Name:KALLAS
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-645-7400
Mailing Address - Street 1:PO BOX 11677
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-1677
Mailing Address - Country:US
Mailing Address - Phone:904-745-0302
Mailing Address - Fax:904-745-0750
Practice Address - Street 1:12740 ATLANTIC BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6111
Practice Address - Country:US
Practice Address - Phone:904-220-8311
Practice Address - Fax:904-220-8313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICAL THERAPY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY908WOtherBCBS FL
FL102330OtherAVMED
FL5490100OtherAETNA
FL880295500Medicaid
FL5490100OtherAETNA
FL880295500Medicaid