Provider Demographics
NPI:1821156761
Name:PREMIER PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:RZEPKA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-379-7913
Mailing Address - Street 1:5432 BEE RIDGE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1514
Mailing Address - Country:US
Mailing Address - Phone:941-379-7913
Mailing Address - Fax:941-379-4614
Practice Address - Street 1:5432 BEE RIDGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1514
Practice Address - Country:US
Practice Address - Phone:941-379-7913
Practice Address - Fax:941-379-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3609261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4512Medicare ID - Type UnspecifiedPHYSICAL THERAPY