NPIMap

Organization Active NPI

Magnolia Rehab Services

Doing business as Magnolia Pediatric Therapy

  • Speech-Language Pathologist
  • Fort Walton Beach, FL
National Provider Identifier
1235457052
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA 7938 Issued in FL
Legal business name
MAGNOLIA REHAB SERVICES
Doing business as
Magnolia Pediatric Therapy
Practice address
1200 Crosswinds LNDG
Fort Walton Beach, FL 32547-1174
Phone
(850) 226-8279
Fax
(850) 226-8326
NPI assigned
May 5, 2010
Last updated
Sep 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Authorized official

Name
Mary C Nix, MS, CCC-SLPNPI 1134164320
Title
Clinic Director
Phone
(850) 226-8279

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X SA 7938 FL Primary

Addresses

Primary practice location

1200 Crosswinds LNDG
Fort Walton Beach, FL 32547-1174

Mailing address

1200 Crosswinds LNDG
Fort Walton Beach, FL 32547-1174
Phone (850) 226-8279

Other names 1

  • Magnolia Pediatric Therapy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Magnolia Rehab Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1200 Crosswinds Lndg
Fort Walton Beach, FL 32547
Phone (850) 226-8279

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1273017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1235457052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CROSSWINDS LNDG",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471174",
            "telephone_number": "850-226-8279",
            "fax_number": "850-226-8326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CROSSWINDS LNDG",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471174",
            "telephone_number": "850-226-8279",
            "fax_number": "850-226-8326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA REHAB SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-05",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "NIX",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "850-226-8279",
        "authorized_official_credential": "MS, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA 7938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Pediatric Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Magnolia Pediatric Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.