1831624527 NPI number — PT SOLUTIONS OF PENSACOLA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831624527 NPI number — PT SOLUTIONS OF PENSACOLA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PT SOLUTIONS OF PENSACOLA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831624527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 441146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30160-9522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-403-3632
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 PONTE VEDRA PARK DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
PONTE VEDRA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32082-6619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-932-3629
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
JAMESON
Authorized Official First Name:
KELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
678-932-3629

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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