Providian Functional Capacity Specialists

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

AL1714 Issued in FL

Legal business name

PROVIDIAN FUNCTIONAL CAPACITY SPECIALISTS

Doing business as

Providian Physical Therapy and Functional Capacity Specialists

Practice address

716 N Orange Ave
Green Cove Springs, FL 32043-2920

Phone

(888) 957-3337

Fax

(904) 284-4244

NPI assigned

Mar 4, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brian Scott Imler, BA, A.T.,C/L

Title

President

Phone

(904) 982-5762

Specialties & licenses 1

Addresses

Other names 1

• Providian Physical Therapy and Functional Capacity Specialists Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362355200000",
    "number": "1013258862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 N ORANGE AVE",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "320432920",
            "telephone_number": "888-957-3337",
            "fax_number": "904-284-4244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 N ORANGE AVE",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "320432920",
            "telephone_number": "888-957-3337",
            "fax_number": "904-284-4244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDIAN FUNCTIONAL CAPACITY SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-04",
        "last_updated": "2013-03-04",
        "status": "A",
        "authorized_official_last_name": "IMLER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-982-5762",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BA, A.T.,C/L"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "AL1714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providian Physical Therapy and Functional Capacity Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gina Perrone, ACA, BC-HIS
• Amy Phan
• Pinnacle Wellness Healthcare Services
• George Edward Platt, M.D.
• Preferred Touch Healthcare Services LLC
• Ruth Esther Pruitt, RMHI
• Katherine Kelli Pryce
• Christopher Lawrence Pulliam, D.P.M.
• Radiology Associates of Tampa PA
• Ivette Arlene Ramos Acevedo, LMSW

• Physical Therapy Clinic/Center in Green Cove Springs, FL
• Providers in Green Cove Springs, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.