NPIMap

Individual provider Active NPI

Robert Lane Ferreira, DPT, OCS, MTC

  • Physical Therapist
  • St Augustine, FL
National Provider Identifier
1265618987
Registry record updated May 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
23808 Issued in FL
Practice address
190 Southpark Blvd
Suite 100
St Augustine, FL 32086-4120
Phone
(904) 824-1478
Fax
(904) 824-8071
NPI assigned
Jan 11, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 23808 FL Primary

Addresses

Primary practice location

190 Southpark Blvd
Suite 100
St Augustine, FL 32086-4120

Mailing address

190 Southpark Blvd
Suite 100
St Augustine, FL 32086-4120
Phone (904) 824-1478

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
23808FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Effingham Rehab Services, LLC Past Accepting new patients
Effingham Rehab Services, LLC Physical Therapist Past Accepting new patients
Genesis Rehabilitation Hospital, Inc. Past Accepting new patients
Effingham Rehab Services, LLC Past Accepting new patients
Effingham Rehab Services, LLC Past Accepting new patients
Genesis Rehabilitation Hospital, Inc. Past Accepting new patients
Effingham Rehab Services, LLC Past Accepting new patients

Networks

  • Freedom Health HMO Network

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400112000000",
    "number": "1265618987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 SOUTHPARK BLVD",
            "address_2": "SUITE 100",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864120",
            "telephone_number": "904-824-1478",
            "fax_number": "904-824-8071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 SOUTHPARK BLVD",
            "address_2": "SUITE 100",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864120",
            "telephone_number": "904-824-1478",
            "fax_number": "904-824-8071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERREIRA",
        "first_name": "ROBERT",
        "middle_name": "LANE",
        "name_prefix": "Dr.",
        "credential": "DPT, OCS, MTC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-11",
        "last_updated": "2014-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "23808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; 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.