Provider Demographics
NPI:1821855586
Name:PREMIER PHYSICAL THERAPY AND REHABILITATION OF JACKSONVILLE, INC
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY AND REHABILITATION OF JACKSONVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:KOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-996-6922
Mailing Address - Street 1:4320 PABLO PROFESSIONAL CT # 155
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 FAIRFIELD BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4628
Practice Address - Country:US
Practice Address - Phone:904-996-6922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty