Basic Information
| Provider Information | |||||||||
| NPI: | 1700219599 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER REHAB MANAGEMENT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 441146 | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301609522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709171395 | ||||||||
| FaxNumber: | 7704233369 | ||||||||
| Practice Location | |||||||||
| Address1: | 16201 PANAMA CITY BEACH PKWY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PANAMA CITY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324135301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789323629 | ||||||||
| FaxNumber: | 7704233369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2013 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | PHILPOT | ||||||||
| AuthorizedOfficialFirstName: | CARMEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 6784033568 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.