NPIMap

Organization Active NPI

Pro-Motion Physical Therapy of Volusia Cty

  • Physical Therapist
  • Port Orange, FL
National Provider Identifier
1386895050
Registry record updated Apr 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7269 Issued in FL
Legal business name
PRO-MOTION PHYSICAL THERAPY OF VOLUSIA CTY
Practice address
4606 S Clyde Morris Blvd
Suite 1-D
Port Orange, FL 32129-6404
Phone
(386) 492-2986
Fax
(386) 492-2987
NPI assigned
Sep 30, 2008
Last updated
Apr 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2015

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

Authorized official

Name
Marie Carmen Yu, P.T.NPI 1932325545
Title
President
Phone
(386) 492-2986

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 7269 FL Primary

Addresses

Primary practice location

4606 S Clyde Morris Blvd
Suite 1-D
Port Orange, FL 32129-6404

Mailing address

PO Box 290699
Port Orange, FL 32129-0699
Phone (386) 492-2986

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150430000029 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5294882254 Receives reassigned benefits from 2 practitioners
Practice locations: Port Orange, FL

National Provider Directory

National Provider Directory

Locations

4550 Clyde Morris Blvd
Ste D
Port Orange, FL 32129
Phone (386) 238-9355

4606 Clyde Morris Blvd
Ste 1D
Port Orange, FL 32129
Phone (386) 492-2986

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1386895050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290699",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321290699",
            "telephone_number": "386-492-2986",
            "fax_number": "386-492-2987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4606 S CLYDE MORRIS BLVD",
            "address_2": "SUITE 1-D",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296404",
            "telephone_number": "386-492-2986",
            "fax_number": "386-492-2987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-MOTION PHYSICAL THERAPY OF VOLUSIA CTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-30",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "YU",
        "authorized_official_first_name": "MARIE CARMEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-492-2986",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "7269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; 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.