NPIMap

Organization Active NPI

Active Lifestyles Wellness & Performance Ctr

  • Physical Therapist
  • Vero Beach, FL
National Provider Identifier
1154378875
Registry record updated Feb 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT22446 Issued in FL
Legal business name
ACTIVE LIFESTYLES WELLNESS & PERFORMANCE CTR
Practice address
1715 37TH PL
Third Floor
Vero Beach, FL 32960-4502
Phone
(772) 978-7379
Fax
(772) 539-8515
NPI assigned
May 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2018

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

Authorized official

Name
Dr. Giorgio G Res, D.C., P.T.
Title
Owner
Phone
(772) 978-7379

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH9113 FL
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT22446 FL Primary

Addresses

Primary practice location

1715 37TH PL
Third Floor
Vero Beach, FL 32960-4502

Mailing address

1715 37TH PL
Third Floor
Vero Beach, FL 32960-4502
Phone (772) 978-7379

Other identifiers 2

IdentifierTypeStateIssuer
60994OtherFLBCBS- DR. RES
77915OtherFLBCBS GROUP #

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518480000000",
    "number": "1154378875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 37TH PL",
            "address_2": "THIRD FLOOR",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604502",
            "telephone_number": "772-978-7379",
            "fax_number": "772-539-8515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 37TH PL",
            "address_2": "THIRD FLOOR",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604502",
            "telephone_number": "772-978-7379",
            "fax_number": "772-539-8515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFESTYLES WELLNESS & PERFORMANCE CTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2018-02-13",
        "status": "A",
        "authorized_official_last_name": "RES",
        "authorized_official_first_name": "GIORGIO",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-978-7379",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C., P.T."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9113",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT22446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS- DR. RES",
            "identifier": "60994",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "77915",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vero Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2018; 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.