Organization
PREMIER NEURO THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ZACHARY MICHAEL (COO/CFO)
(717) 357-2349
Entity
Organization
Contact information
Practice address
14255 BEACH BLVD, JACKSONVILLE, FL 32250-1576
(904) 470-0673
Mailing address
13700 SUTTON PARK DR N, APT. 816, JACKSONVILLE, FL 32224-2273
(904) 470-0673
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Enumeration date
04/04/2017
Last updated
04/04/2017
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