Functional Vitality

Key facts

NPI

1336879741

Entity type

Organization (NPI type 2)

Primary specialty

Occupational Therapist 225X00000X

Legal business name

FUNCTIONAL VITALITY

Practice address

680 Grandview Rd
Mansfield, GA 30055-2571

Phone

(678) 278-8348

NPI assigned

Jun 16, 2022

Organization subpart

Yes

Parent organization (as reported)

FUNCTIONAL VITALITY

Authorized official

Name

Latess Echavarria, OT NPI 1013457084

Title

Owner

Phone

(470) 266-0623

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Functional Vitality Occupational Therapist · Conyers, GA · NPI 1497484778
  NPPES parent name

Corporate family (same tax ID) 1

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

• Functional Vitality Occupational Therapist · Conyers, GA · NPI 1497484778
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Latess Echavarria Occupational Therapist · Buford, GA · NPI 1013457084
  NPD Authorized official OCCUPATIONAL THERAPIST

National Provider Directory

Tax ID family

Functional Vitality (2 organizations share this tax ID)

Part of

Functional Vitality

Specialties & licenses

Addresses

Other names

• Functional Vitality Home Health Services Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 16, 2022.

{
    "created_epoch": "1655337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655337600000",
    "number": "1336879741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 GRANDVIEW RD",
            "city": "MANSFIELD",
            "state": "GA",
            "postal_code": "300552571",
            "telephone_number": "470-266-0623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 GRANDVIEW RD",
            "city": "MANSFIELD",
            "state": "GA",
            "postal_code": "300552571",
            "telephone_number": "678-278-8348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL VITALITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FUNCTIONAL VITALITY",
        "enumeration_date": "2022-06-16",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A",
        "authorized_official_last_name": "ECHAVARRIA",
        "authorized_official_first_name": "LATESS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "470-266-0623",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Functional Vitality Home Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, GA

• Anna M Karns
• Alexia Ford, LCSW

All providers in Mansfield, GA · Occupational Therapist in Georgia