Physical Medicine and Rehabilitation, PA

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

ME95874 Issued in FL

Legal business name

PHYSICAL MEDICINE AND REHABILITATION, PA

Practice address

1133 Saxon Blvd
Orange City, FL 32763-8470

Phone

(386) 775-7080

Fax

(386) 775-8070

NPI assigned

Aug 30, 2007

Last updated

Mar 26, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Robert Coolidge

Title

Agent/Representative

Phone

(386) 774-5211

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238025600000",
    "number": "1437343795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741240",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327741240",
            "telephone_number": "386-774-5211",
            "fax_number": "386-774-5251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 SAXON BLVD",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638470",
            "telephone_number": "386-775-7080",
            "fax_number": "386-775-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL MEDICINE AND REHABILITATION, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-30",
        "last_updated": "2009-03-26",
        "status": "A",
        "authorized_official_last_name": "COOLIDGE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "AGENT/REPRESENTATIVE",
        "authorized_official_telephone_number": "386-774-5211",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "ME95874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "93047",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278513700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "D02637",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00667019",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marianne Pesci de Matos Moreira, CNM
• Peters Chiropractic Center, P.a.
• Veronica Faye Petkus, MS, LMHC
• Zephaniah Elizabeth Philippe, PA-C
• Physical Medicine & Rehabilitation PA
• Physician First Management Co. LLC
• Carhine Pierre-Lambert, MD
• Madelynn Pietroburgo
• Amy Pike
• Charlene Yadira Pineda, OD

• Physical Medicine & Rehabilitation Physician in Orange City, FL
• Providers in Orange City, FL by specialty
• Physical Medicine & Rehabilitation Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.