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Organization Active NPI

Easterseals Northeast Central Florida

Doing business as Easter Seals

  • Pediatric Physical Therapist
  • Daytona Beach, FL
National Provider Identifier
1376631747
Registry record updated May 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
PT 14797 Issued in FL
Legal business name
EASTERSEALS NORTHEAST CENTRAL FLORIDA
Doing business as
Easter Seals
Practice address
1219 Dunn Ave
Daytona Beach, FL 32114
Phone
(386) 255-4568
Fax
(386) 258-7677
NPI assigned
Oct 11, 2006
Last updated
May 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2018

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

Authorized official

Name
Ms. Beverly Johnson
Title
Ceo (President)
Phone
(386) 255-4568

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X PT 14797 FL Primary

Addresses

Primary practice location

1219 Dunn Ave
Daytona Beach, FL 32114

Mailing address

1219 Dunn Ave
Daytona Beach, FL 32114-2405
Phone (386) 255-4568

Other identifiers 1

IdentifierTypeStateIssuer
883828300MedicaidFL

Other names 1

  • Easter Seals Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Easterseals Northeast Central Florida Inc25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527552000000",
    "number": "1376631747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 DUNN AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142405",
            "telephone_number": "386-255-4568",
            "fax_number": "386-258-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 DUNN AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-255-4568",
            "fax_number": "386-258-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERSEALS NORTHEAST CENTRAL FLORIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2018-05-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "CEO (PRESIDENT)",
        "authorized_official_telephone_number": "386-255-4568",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "FL",
            "license": "PT 14797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "883828300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Easter Seals",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Easter Seals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; 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.