Provider Demographics
NPI:1700230620
Name:CONCIERGE PHYSICAL THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:CONCIERGE PHYSICAL THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:941-447-8040
Mailing Address - Street 1:2825 TERRA CEIA BAY BLVD
Mailing Address - Street 2:#1702
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5989
Mailing Address - Country:US
Mailing Address - Phone:941-447-8040
Mailing Address - Fax:
Practice Address - Street 1:3103 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-3350
Practice Address - Country:US
Practice Address - Phone:941-447-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-17
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11720261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy