Provider Demographics
NPI:1730228743
Name:PENEMARIE K MURPHY INC
Entity type:Organization
Organization Name:PENEMARIE K MURPHY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENEMARIE
Authorized Official - Middle Name:KALLAS
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-645-7400
Mailing Address - Street 1:PO BOX 11677
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-1677
Mailing Address - Country:US
Mailing Address - Phone:904-645-7400
Mailing Address - Fax:904-745-0750
Practice Address - Street 1:7001 MERRILL RD STE 27
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2600
Practice Address - Country:US
Practice Address - Phone:904-745-0302
Practice Address - Fax:904-745-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0005355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0803Medicare ID - Type UnspecifiedPROVIDER NUMBER