Magnolia Rehab Services
Organization Active NPI Speech-Language Pathologist · Fort Walton Beach, FL
NPI 1235457052 · NPPES record last updated Sep 29, 2022
Key facts
- NPI
- 1235457052
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SA 7938 (FL)
- Legal business name
- MAGNOLIA REHAB SERVICES
- Practice address
- 1200 Crosswinds LNDG
Fort Walton Beach, FL 32547-1174 - Phone
- (850) 226-8279
- Fax
- (850) 226-8326
- NPI assigned
- May 5, 2010
- Organization subpart
- No
Authorized official
- Name
- Mary C Nix, MS, CCC-SLP
- Title
- Clinic Director
- Phone
- (850) 226-8279
Corporate family (same tax ID) 5
Practitioners 7
-
Autum Marie Edgerton, SLP
-
Netzna Kondrashevich, SLP
National Provider Directory
- Tax ID family
- Magnolia Rehab Services
Locations
1200 Crosswinds Lndg
Fort Walton Beach, FL 32547
Phone (850) 226-8279
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist |
235Z00000X | SA 7938 | FL | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 111422500 | Medicaid | FL |
Other names
- Magnolia Pediatric Therapy
Other providers in Fort Walton Beach, FL
- Shannon Macmaster
- Kelsey Elizabeth Maddry-Smith
- Venkata R Magisetty
- Magnolia Manor Senior Day Program, LLC
- Magnolia Medical Clinic P.a.
- Victoria Magnuson
- Paula Magtanong
- Daanish Mahmood
- Heather Ann Mahnken
- Cavan Mair
All providers in Fort Walton Beach, FL · Speech-Language Pathologist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.