NPIMap

Organization Active NPI

Longevity Rehabilitation Center Inc

  • Physical Therapy Clinic/Center
  • Vero Beach, FL
National Provider Identifier
1215096383
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
HCC5143 Issued in FL
Legal business name
LONGEVITY REHABILITATION CENTER INC
Practice address
1515 Indian River Blvd
Suite A135
Vero Beach, FL 32960
Phone
(772) 978-9750
Fax
(772) 978-9748
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Paul R St Mary
Title
Director of Operations
Phone
(772) 978-9750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X HCC5143 FL Primary

Addresses

Primary practice location

1515 Indian River Blvd
Suite A135
Vero Beach, FL 32960

Mailing address

1515 Indian River Blvd
Suite A135
Vero Beach, FL 32960
Phone (772) 978-9750

Other names 1

  • Longevity Rehab Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130805000634 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0345238218 Receives reassigned benefits from 17 practitioners
Practice locations: Sebastian, FL; Vero Beach, FL

National Provider Directory

National Provider Directory

Locations

13000 US Highway 1
Ste 7
Sebastian, FL 32958
Phone (772) 581-8326

8802 N US Highway 1
Ste 7
Sebastian, FL 32958

8802 N US Highway 1
Ste 5
Sebastian, FL 32958

9055 Americana Rd
Ste 20
Vero Beach, FL 32966
Phone (772) 774-8392

1515 Indian River Blvd
Ste A135
Vero Beach, FL 32960
Phone (772) 978-9750

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215096383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 INDIAN RIVER BLVD",
            "address_2": "SUITE A135",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "32960",
            "telephone_number": "772-978-9750",
            "fax_number": "772-978-9748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 INDIAN RIVER BLVD",
            "address_2": "SUITE A135",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "32960",
            "telephone_number": "772-978-9750",
            "fax_number": "772-978-9748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY REHABILITATION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ST MARY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "772-978-9750",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "HCC5143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Longevity Rehab Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.