NPIMap

Organization Active NPI

Space Coast Lymphedema Clinic LLC

  • Physical Therapist
  • Viera, FL
National Provider Identifier
1477959856
Registry record updated Apr 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT14733 Issued in FL
Legal business name
SPACE COAST LYMPHEDEMA CLINIC LLC
Practice address
7000 Spyglass CT.
Suite 120
Viera, FL 32940
Phone
(321) 241-6543
Fax
(321) 241-6513
NPI assigned
Nov 12, 2014
Last updated
Apr 25, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2018

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

Authorized official

Name
Mrs. Rosanne Bessenaire, PTNPI 1194125880
Title
Ceo
Phone
(321) 241-6543

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT14733 FL Primary
Occupational Therapist 225X00000X OT12356 FL

Addresses

Primary practice location

7000 Spyglass CT.
Suite 120
Viera, FL 32940

Mailing address

7000 Spyglass CT.
Suite 120
Viera, FL 32940
Phone (321) 241-6543

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150402000843 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9638495724 Receives reassigned benefits from 6 practitioners
Practice locations: Viera, FL
O20250903000424 FL DME Supplier - Independently-Practicing Occupational TherapistDME Supplier - Independently-Practicing Physical Therapist 9638495724 Practice locations: Viera, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1415750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524614400000",
    "number": "1477959856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7000 SPYGLASS CT.",
            "address_2": "SUITE 120",
            "city": "VIERA",
            "state": "FL",
            "postal_code": "32940",
            "telephone_number": "321-241-6543",
            "fax_number": "321-241-6513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 SPYGLASS CT.",
            "address_2": "SUITE 120",
            "city": "VIERA",
            "state": "FL",
            "postal_code": "32940",
            "telephone_number": "321-241-6543",
            "fax_number": "321-241-6513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST LYMPHEDEMA CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-12",
        "last_updated": "2018-04-25",
        "status": "A",
        "authorized_official_last_name": "BESSENAIRE",
        "authorized_official_first_name": "ROSANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "321-241-6543",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT14733",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT12356",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Viera, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; 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.