NPIMap

Organization Active NPI

Pure PT Physical Therapy LLC

  • Physical Therapist
  • Orange City, FL
National Provider Identifier
1417633868
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PURE PT PHYSICAL THERAPY LLC
Practice address
2864 Wellness Ave Ste 100
Orange City, FL 32763-8335
Phone
(386) 575-4027
Fax
(386) 575-4028
NPI assigned
Jun 22, 2023
Last updated
Jun 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Authorized official

Name
Dr. Paul Kudlick, PT, DPTNPI 1194239459
Title
Owner/Physical Therapist
Phone
(386) 575-4027

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 Therapist 225100000X NU Primary

Addresses

Primary practice location

2864 Wellness Ave Ste 100
Orange City, FL 32763-8335

Mailing address

2864 Wellness Ave Ste 100
Orange City, FL 32763-8335
Phone (386) 575-4027

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230816000830 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6406218924 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
Practice locations: Lake Mary, FL; Orange City, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pure PT Physical Therapy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2864 Wellness Ave
Ste 100
Orange City, FL 32763
Phone (386) 218-0564

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1687392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1417633868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2864 WELLNESS AVE STE 100",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638335",
            "telephone_number": "386-575-4027",
            "fax_number": "386-575-4028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2864 WELLNESS AVE STE 100",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638335",
            "telephone_number": "386-575-4027",
            "fax_number": "386-575-4028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE PT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-22",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "KUDLICK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "386-575-4027",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; 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.