Prodigy Medical

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PRODIGY MEDICAL

Practice address

222 Seabreeze Cir
Jupiter, FL 33477-6420

Phone

(561) 277-9107

NPI assigned

Apr 16, 2009

Organization subpart

No

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

Authorized official

Name

Yvette Vandiver

Title

Owner

Phone

(561) 277-9107

Specialties & licenses 5

Addresses

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

{
    "created_epoch": "1239840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239840000000",
    "number": "1386887602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 SEABREEZE CIR",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334776420",
            "telephone_number": "561-277-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 SEABREEZE CIR",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334776420",
            "telephone_number": "561-277-9107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGY MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-16",
        "last_updated": "2009-04-16",
        "status": "A",
        "authorized_official_last_name": "VANDIVER",
        "authorized_official_first_name": "YVETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-277-9107"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2009; 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.