Legacy Healthcare Services Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

LEGACY HEALTHCARE SERVICES INC

Practice address

5103 Cold Harbor Dr
Tallahassee, FL 32312-4148

Phone

(855) 239-3467

NPI assigned

Mar 1, 2021

Organization subpart

No

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

Authorized official

Name

Mr. William Gil Wilson Jr.

Title

Chief Financial Officer

Phone

(919) 424-5080

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 696505

Legal name

LEGACY HEALTHCARE SERVICES INC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Feb 22, 2022

Last certification

Aug 1, 2024

Ownership / control type

Voluntary Non-Profit Other Than Church

Facility address

5103 Cold Harbor Dr
Tallahassee, FL 32312

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

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

{
    "created_epoch": "1614556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614556800000",
    "number": "1275127326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 SPRING FOREST RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276162815",
            "telephone_number": "910-724-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5103 COLD HARBOR DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323124148",
            "telephone_number": "855-239-3467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTHCARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-01",
        "last_updated": "2021-03-01",
        "certification_date": "2021-02-26",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GIL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "919-424-5080",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Gonzalez Lee
• Tiffany Jane Lee
• Zachary Lee
• Lee'S Place, Inc.
• Annette Lefranc, PHARMD
• Legacy Homecare Group, LLC
• Legacy Private Care of Tallahassee, LLC
• Legacy Rose United Care Group, LLC.
• Noreen Legare, PH.D.
• Mya Leger

• Physical Therapist in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.