Vital Rehabilitation LLC.

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

Legal business name

VITAL REHABILITATION LLC.

Practice address

3600 Peoria Rd Ste 203
Orange Park, FL 32065-7686

Phone

(904) 657-0089

Fax

(904) 560-5283

NPI assigned

Dec 1, 2014

Last updated

Jan 31, 2024By 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

Jennifer Amanda Justice, DPT, SCSNPI 1891948774

Title

Owner, Clinician

Phone

(904) 657-0089

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Vital Sports and Wellness Other name

Tax ID family

Vital Rehabilitation LLC2 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.

• Vital Rehabilitation LLC

  • Physical Therapist
  • Orange Park, FL
  • NPI 1780132662
  NPD tax ID

Locations

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.

• Jennifer Amanda Justice, DPT, SCS

  • Physical Therapist
  • Orange Park, FL
  • NPI 1891948774
  NPD Authorized official

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

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1639576093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2216 GREEN HERON CT",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320038600",
            "telephone_number": "904-434-5737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 PEORIA RD STE 203",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320657686",
            "telephone_number": "904-657-0089",
            "fax_number": "904-560-5283"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1525 Virgils Way Unit 1",
            "address_purpose": "LOCATION",
            "city": "Green Cove Springs",
            "state": "FL",
            "postal_code": "320433780",
            "country_code": "US",
            "telephone_number": "904-657-0089",
            "fax_number": "904-560-5283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITAL REHABILITATION LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-01",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER, CLINICIAN",
        "authorized_official_telephone_number": "904-657-0089",
        "authorized_official_credential": "DPT, SCS"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSAGE THERAPY",
            "identifier": "MA38374",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vital Sports and Wellness",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Vital Rehabilitation LLC
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• VK Medical Group LLC (Back & Neck Institute)
• VK Medical Group LLC
• Jossette Trinh Vo, DMD
• Alicia Vogt, DPT

• Sports Physical Therapist in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Sports Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.