Florida Therapy Center of Melbourne LLC

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

Legal business name

FLORIDA THERAPY CENTER OF MELBOURNE LLC

Practice address

635 S Wickham Rd Ste 103
Melbourne, FL 32904-1436

Phone

(321) 890-7439

Fax

(321) 768-1710

NPI assigned

May 2, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Mathew Simon Kronman, MPTNPI 1013157239

Title

Administrator

Phone

(321) 890-7439

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Comprehensive outpatient rehabilitation facility certification: CCN 684843

Legal name

FLORIDA THERAPY CENTER OF MELBOURNE LLC

Certification status

Active

Provider type (POS)

Comprehensive outpatient rehabilitation facility

Participating since

Mar 18, 2003

Last certification

Apr 16, 2019

Ownership / control type

Proprietary

Facility address

1990 W New Haven Ave Ste 105
Melbourne, FL 32904

Locations

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mathew Simon Kronman, P.T.

  • Physical Therapist
  • Melbourne, FL
  • NPI 1013157239
  NPD (past) Authorized official
• Onna Brewer, PH.D.

  • Psychologist
  • Indialantic, FL
  • NPI 1396152096
  NPD (past)
• Linda Fadden, OT

  • Occupational Therapist
  • Palm Bay, FL
  • NPI 1679713721
  NPD (past)
• Valerie Gerke, M.A. CCC-SLP

  • Speech-Language Pathologist
  • Melbourne, FL
  • NPI 1578004297
  NPD (past)
• Susan J Jacksland, OTR

  • Specialist
  • Melbourne, FL
  • NPI 1790803229
  NPD (past)
• Ana Joly, RT

  • Pulmonary Rehabilitation Certified Respiratory Therapist
  • Melbourne, FL
  • NPI 1225600075
  NPD (past)
• Lymuel Jones, RT

  • Registered Respiratory Therapist
  • Melbourne, FL
  • NPI 1386181634
  NPD (past)
• Jennifer Rose Middleton, RRT

  • Registered Respiratory Therapist
  • Melbourne, FL
  • NPI 1225508716
  NPD (past)
• Lauren Nicole Myers, OTR

  • Occupational Therapist
  • Melbourne, FL
  • NPI 1164901583
  NPD (past)
• Joshua Aaron Pearson, PTA

  • Physical Therapy Assistant
  • Melbourne, FL
  • NPI 1174038525
  NPD (past)
• Denise Philistin, RT

  • Pulmonary Rehabilitation Certified Respiratory Therapist
  • Melbourne, FL
  • NPI 1417602939
  NPD (past)
• Daniel Redlien, PTA

  • Physical Therapy Assistant
  • Melbourne, FL
  • NPI 1922681436
  NPD (past)

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1144288986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 S WICKHAM RD STE 103",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329041436",
            "telephone_number": "321-890-7439",
            "fax_number": "321-768-1710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 S WICKHAM RD STE 103",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329041436",
            "telephone_number": "321-890-7439",
            "fax_number": "321-768-1710"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1747 Evans Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "32904",
            "country_code": "US",
            "telephone_number": "321-768-6119",
            "fax_number": "321-768-1710",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1990 W New Haven Ave Ste 105",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329043908",
            "country_code": "US",
            "telephone_number": "321-768-6119",
            "fax_number": "321-768-1710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FLORIDA THERAPY CENTER OF MELBOURNE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "KRONMAN",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_middle_name": "SIMON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-890-7439",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "GF7",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Comprehensive Outpatient Rehabilitation Facility (CORF) in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.