NPIMap

Organization Active NPI

Premier Rehab Inc

Doing business as Fyzical Therapy and Balance Center

  • Rehabilitation Clinic/Center
  • Deland, FL
National Provider Identifier
1467490136
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PREMIER REHAB INC
Doing business as
Fyzical Therapy and Balance Center
Practice address
911 N Spring Garden Ave
Deland, FL 32720
Phone
(386) 736-3108
Fax
(386) 736-3643
NPI assigned
Jun 3, 2006
Last updated
Sep 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Authorized official

Name
Barbara Annette Divincenzo, OTR/L, CHTNPI 1235172859
Title
Administrator/ Ceo
Phone
(386) 736-3108

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X
Rehabilitation Clinic/Center 261QR0400X FL Primary
Occupational Therapist 225X00000X 2674 FL
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

911 N Spring Garden Ave
Deland, FL 32720

Mailing address

911 N Spring Garden Ave
Deland, FL 32720-2560
Phone (386) 736-3108

Other identifiers 3

IdentifierTypeStateIssuer
R5LOtherFLBLUE CROSS & BLUE SHIELD
681664996MedicaidFL
882094500MedicaidFL

Other names 1

  • Fyzical Therapy and Balance Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140626002327 FL Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 1759506157 Practice locations: Deland, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467490136. Details of each certification follow.

  • CCN 106846 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 106846

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
FYZICAL OF DELAND
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Mar 3, 1994
Last certification
Jul 26, 2021
Ownership / control type
Proprietary
Facility address
911 N Spring Garden Ave
De Land, FL 32720

National Provider Directory

National Provider Directory

Locations

909 S Charles Richard Beall Blvd
Ste B
Debary, FL 32713

911 N Spring Garden Ave
Deland, FL 32720
Phone (386) 736-3108

315 N Mangoustine Ave
Sanford, FL 32771
Phone (386) 401-6100

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663200000000",
    "number": "1467490136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 N SPRING GARDEN AVE",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327202560",
            "telephone_number": "386-736-3108",
            "fax_number": "386-736-3643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 N SPRING GARDEN AVE",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "32720",
            "telephone_number": "386-736-3108",
            "fax_number": "386-736-3643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A",
        "authorized_official_last_name": "DIVINCENZO",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "ADMINISTRATOR/ CEO",
        "authorized_official_telephone_number": "386-736-3108",
        "authorized_official_credential": "OTR/L, CHT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "2674",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "R5L",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "681664996",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "882094500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fyzical Therapy and Balance Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deland, FL

Sources for this page

Verify at the official NPI Registry.