NPIMap

Organization Active NPI

Pro Vita Physical Therapy LLC

Doing business as Pro Vita Physical Therapy - Shalimar

  • Physical Therapist
  • Fort Walton Beach, FL
National Provider Identifier
1841944535
Registry record updated Sep 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PRO VITA PHYSICAL THERAPY LLC
Doing business as
Pro Vita Physical Therapy - Shalimar
Pro Vita Physical Therapy-FWB
Practice address
411 Racetrack Rd NE
Fort Walton Beach, FL 32547-2503
Phone
(850) 331-3017
Fax
(855) 978-1838
NPI assigned
Feb 10, 2022
Last updated
Sep 21, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
PRO VITA PHYSICAL THERAPY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2026

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

Authorized official

Name
Carla J Bulla, MED, PT, DPT, ATCNPI 1558547406
Title
Ceo/ Founder
Phone
(850) 331-3017

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

411 Racetrack Rd NE
Fort Walton Beach, FL 32547-2503

Mailing address

279 Texas Pkwy
Crestview, FL 32536-2125
Phone (850) 331-3017

Other names 2

  • Pro Vita Physical Therapy - Shalimar Doing business as
  • Pro Vita Physical Therapy-FWB Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pro Vita Physical Therapy6 organizations share this tax ID, including this one
Part of
Pro Vita Physical Therapy

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

638 N Ferdon Blvd
Ste 1
Crestview, FL 32536
Phone (850) 331-3017

411 Racetrack Rd NE
Fort Walton Beach, FL 32547
Phone (850) 331-3017

5941 Berryhill Rd
Ste 1
Milton, FL 32570

1987 Highway 87
Navarre, FL 32566
Phone (850) 331-3017

4 9th Ave
Ste G
Shalimar, FL 32579
Phone (205) 919-9349

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 7

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": "1644451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789948800000",
    "number": "1841944535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "279 TEXAS PKWY",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325362125",
            "telephone_number": "850-331-3017",
            "fax_number": "855-975-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 RACETRACK RD NE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325472503",
            "telephone_number": "850-331-3017",
            "fax_number": "855-978-1838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO VITA PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRO VITA PHYSICAL THERAPY, LLC",
        "enumeration_date": "2022-02-10",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A",
        "authorized_official_last_name": "BULLA",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO/ FOUNDER",
        "authorized_official_telephone_number": "850-331-3017",
        "authorized_official_credential": "MED, PT, DPT, ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro Vita Physical Therapy - Shalimar",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pro Vita Physical Therapy-FWB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2026; 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.