Provider Demographics
NPI:1811185291
Name:UNIVERSITY REHABILITATION, LLC
Entity Type:Organization
Organization Name:UNIVERSITY REHABILITATION, LLC
Other - Org Name:UNIVERSITY REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-756-0077
Mailing Address - Street 1:PO BOX 8600
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34985-8600
Mailing Address - Country:US
Mailing Address - Phone:772-335-7966
Mailing Address - Fax:772-335-7963
Practice Address - Street 1:733 DUNLAWTON AVE
Practice Address - Street 2:STE 103
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4225
Practice Address - Country:US
Practice Address - Phone:386-756-0077
Practice Address - Fax:386-756-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 4660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLX1320Medicare PIN
FLY2745Medicare PIN
FLY2745ZMedicare PIN