Functional Therapy and Wellness LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

FUNCTIONAL THERAPY AND WELLNESS LLC

Practice address

2715 Knox McRae Dr
Titusville, FL 32780-5113

Phone

(321) 202-3323

NPI assigned

Apr 16, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Shane H. Rosonina, DPT

Title

Doctor of Physical Therapy

Phone

(321) 202-3323

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1586995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587945600000",
    "number": "1144840414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 KNOX MCRAE DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327805113",
            "telephone_number": "321-202-3323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 KNOX MCRAE DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327805113",
            "telephone_number": "321-202-3323"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4350 N Atlantic Ave",
            "address_purpose": "LOCATION",
            "city": "Cocoa Beach",
            "state": "FL",
            "postal_code": "329313656",
            "country_code": "US",
            "telephone_number": "321-202-3323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FUNCTIONAL THERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-16",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A",
        "authorized_official_last_name": "ROSONINA",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "DOCTOR OF PHYSICAL THERAPY",
        "authorized_official_telephone_number": "321-202-3323",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fred and Linda Kodesch, MDS
• Mallory Freeman
• Vivian Mashell Freeman, M.A.
• Anita Frost-Lindenblad, ARNP
• Kristie M Fuller, LMHC
• Jeanette Maria Gabay
• Amy Adams Gadapee, M.S. CCC-SLP
• Elizabeth Turner Galfo, MD
• Mark S Galfo, MD
• Francisco A Garcia, M.D.

• Physical Therapy Clinic/Center in Titusville, FL
• Providers in Titusville, 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 Apr 27, 2020; 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.