NPIMap

Organization Active NPI

Impression Home Healthcare & Therapy

  • Physical Therapy Clinic/Center
  • Fort Pierce, FL
National Provider Identifier
1508539586
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
IMPRESSION HOME HEALTHCARE & THERAPY
Practice address
1701 N 14TH St
Fort Pierce, FL 34950-2113
Phone
(561) 206-2289
NPI assigned
Jul 27, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Authorized official

Name
Roseguene Stephen
Title
Managing Director
Phone
(561) 860-1339

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Pediatric Rehabilitation Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P0010X
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081S0010X
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Case Management Agency 251B00000X
Public Health or Welfare Agency 251K00000X
Early Intervention Provider Agency 252Y00000X
Developmental Disabilities Clinic/Center 261QD1600X
Physical Therapy Clinic/Center 261QP2000X Primary
Rehabilitation Clinic/Center 261QR0400X
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

1701 N 14TH St
Fort Pierce, FL 34950-2113

Mailing address

6258 Wauconda Way W
Lake Worth, FL 33463-5870
Phone (561) 860-1339

Other practice location 1

6258 Wauconda Way W
Lake Worth, FL 33463-5870
Phone (561) 860-1339

Other identifiers 1

IdentifierTypeStateIssuer
111802300MedicaidFL

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL Impressionshomehealthcare@gmail.com Direct
CONNECT URL IMPRESSIONSHOMEHEALTHCARE@GMAIL.COM Direct

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1508539586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6258 WAUCONDA WAY W",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334635870",
            "telephone_number": "561-860-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N 14TH ST",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349502113",
            "telephone_number": "561-206-2289"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6258 Wauconda Way W",
            "address_purpose": "LOCATION",
            "city": "Lake Worth",
            "state": "FL",
            "postal_code": "334635870",
            "country_code": "US",
            "telephone_number": "561-860-1339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPRESSION HOME HEALTHCARE & THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-27",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "STEPHEN",
        "authorized_official_first_name": "ROSEGUENE",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "561-860-1339"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111802300",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Impressionshomehealthcare@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Business Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6258 Wauconda Way W",
            "city": "Lake Worth",
            "state": "FL",
            "country_code": "US",
            "postal_code": "334635870",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "IMPRESSIONSHOMEHEALTHCARE@GMAIL.COM",
            "affiliation": "N",
            "endpointDescription": "BUSINESS EMAIL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CORRESPONDENT",
            "address_1": "1701 N 14th St",
            "city": "Fort Pierce",
            "state": "FL",
            "country_code": "US",
            "postal_code": "349502113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.