Functional Vitality

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

FUNCTIONAL VITALITY

Practice address

2375 Wall St SE Ste 240
Conyers, GA 30013-6702

Phone

(678) 278-8348

Fax

(470) 276-3158

NPI assigned

Jun 10, 2022

Last updated

Jun 16, 2022By 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

Latess Echavarria, OTNPI 1013457084

Title

Owner

Phone

(470) 266-0623

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Tax ID family

Functional Vitality2 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.

• Functional Vitality

  dba Functional Vitality Home Health Services

  • Occupational Therapist
  • Mansfield, GA
  • NPI 1336879741
  NPD tax ID

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.

• Functional Vitality

  dba Functional Vitality Home Health Services

  • Occupational Therapist
  • Mansfield, GA
  • NPI 1336879741
  NPPES parent name

Practitioners 1

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.

• Latess Echavarria

  • Occupational Therapist
  • Buford, GA
  • NPI 1013457084
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655337600000",
    "number": "1497484778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 GRANDVIEW RD",
            "city": "MANSFIELD",
            "state": "GA",
            "postal_code": "300552571",
            "telephone_number": "470-266-0623",
            "fax_number": "470-276-3158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 WALL ST SE STE 240",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136702",
            "telephone_number": "678-278-8348",
            "fax_number": "470-276-3158"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1311 Milstead Ave NE",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300123829",
            "country_code": "US",
            "telephone_number": "470-266-0623",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FUNCTIONAL VITALITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-10",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A",
        "authorized_official_last_name": "ECHAVARRIA",
        "authorized_official_first_name": "LATESS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "470-266-0623",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Friends in Transformation LLC
• Talisha M Fulcher, CERTIFIED HAIR LOSS
• Full Medical and Oxygen
• Jana Allen Fuller, N.P.
• Vickie Lorraine Fulwider
• Allen A Futral III, M.D.
• Misty Ann Futrell
• Oscar Cornell Gaines
• Margaret Anne Galbierz, PA-C
• Griselda Gallagher, RN

• Occupational Therapist in Conyers, GA
• Providers in Conyers, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; 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.