NPIMap

Organization Active NPI

Pro Vita Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Navarre, FL
National Provider Identifier
1063185684
Registry record updated Aug 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PRO VITA PHYSICAL THERAPY LLC
Practice address
1987 Highway 87
Navarre, FL 32566-1046
Phone
(850) 710-7163
Fax
(855) 975-2471
NPI assigned
Jul 29, 2021
Organization subpart
Yes
Parent organization
PRO VITA PHYSICAL THERAPY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 24, 2026

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

Authorized official

Name
Carla J Bulla
Title
Owner
Phone
(850) 902-7315

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1987 Highway 87
Navarre, FL 32566-1046

Mailing address

279 Texas Pkwy
Crestview, FL 32536-2125
Phone (850) 710-7163

Other identifiers 1

IdentifierTypeStateIssuer
S0MOAOtherFLFLORIDA BLUE

Other names 1

  • Pro Vita Physical Therapy - Navarre Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pro Vita Physical Therapy - Florala6 organizations share this tax ID, including this one
Part of
Pro Vita Physical Therapy - Florala

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787529600000",
    "number": "1063185684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "279 TEXAS PKWY",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325362125",
            "telephone_number": "850-710-7163",
            "fax_number": "855-975-2471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1987 HIGHWAY 87",
            "city": "NAVARRE",
            "state": "FL",
            "postal_code": "325661046",
            "telephone_number": "850-710-7163",
            "fax_number": "855-975-2471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO VITA PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRO VITA PHYSICAL THERAPY, LLC",
        "enumeration_date": "2021-07-29",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A",
        "authorized_official_last_name": "BULLA",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-902-7315"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "S0MOA",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro Vita Physical Therapy - Navarre",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pro Vita Physical Therapy - Navarre",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Navarre, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; 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.