Forever Active Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

FOREVER ACTIVE PHYSICAL THERAPY LLC

Practice address

10 Ridge Rd
Palm Coast, FL 32137-9808

Phone

(732) 575-3275

NPI assigned

Oct 11, 2022

Last updated

Oct 11, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bradley Puglisi, PT, DPTNPI 1821552100

Title

President

Phone

(732) 575-3275

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

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.

• Bradley Puglisi, PT, DPT

  • Geriatric Physical Therapist
  • Toms River, NJ
  • NPI 1821552100

  FL, Geriatrics

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1665446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1316662364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 RIDGE RD",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321379808",
            "telephone_number": "732-575-3275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 RIDGE RD",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321379808",
            "telephone_number": "732-575-3275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER ACTIVE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-11",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A",
        "authorized_official_last_name": "PUGLISI",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-575-3275",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "www.WebPT.com",
            "affiliation": "N",
            "address_1": "10 Ridge Rd",
            "city": "Palm Coast",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321379808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Flying Nurses International LLC
• Tyler Scott Flynn, DMD
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• Kimberlie Forbes, PT
• Forefront Chiropractic LLC (Forefront Spine & Sport)
• Heather Foss
• Emily Griscom Foster, SW18303
• Four Seasons ABA
• Kayla Elizabeth Fowler
• Frederick A Fox, DDS

• Physical Therapy Clinic/Center in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; 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.