Intentional Wellness

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT18020 Issued in FL

Legal business name

INTENTIONAL WELLNESS

Practice address

2139 W State Road 434
Unit 101
Longwood, FL 32779-5019

Phone

(407) 774-7744

NPI assigned

Feb 9, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Robyn Jennifer Rose, MPT,CST-D

Title

Managing Member/Owner

Phone

(407) 774-7744

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1265673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265673600000",
    "number": "1205168697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2139 W STATE ROAD 434",
            "address_2": "UNIT 101",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327795019",
            "telephone_number": "407-774-7744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2139 W STATE ROAD 434",
            "address_2": "UNIT 101",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327795019",
            "telephone_number": "407-774-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENTIONAL WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-09",
        "last_updated": "2010-02-09",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_middle_name": "JENNIFER",
        "authorized_official_title_or_position": "MANAGING MEMBER/OWNER",
        "authorized_official_telephone_number": "407-774-7744",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPT,CST-D"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT18020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; 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.