Provider Demographics
NPI:1871695585
Name:JORGENSON, BRETT RICHARD (MPT)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:RICHARD
Last Name:JORGENSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8971 HAMPTON LANDING DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4585
Mailing Address - Country:US
Mailing Address - Phone:904-519-7711
Mailing Address - Fax:
Practice Address - Street 1:236 PONTE VEDRA PARK DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082
Practice Address - Country:US
Practice Address - Phone:904-280-3440
Practice Address - Fax:904-280-3444
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0180402251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic