NPIMap

Organization Active NPI

Pro Vita Physical Therapy LLC

Doing business as Pro Vita Physical Therapy - Pensacola

  • Physical Therapist
  • Pensacola, FL
National Provider Identifier
1881404796
Registry record updated Jan 13, 2025
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 - Pensacola
Practice address
4700 Bayou Blvd Ste 1C
Pensacola, FL 32503-2670
Phone
(850) 331-3017
Fax
(855) 595-2306
NPI assigned
Jan 13, 2025
Organization subpart
Yes
Parent organization
PRO VITA PHYSICAL THERAPY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Authorized official

Name
Mrs. Carla J Bulla, PT, DPT
Title
President
Phone
(850) 331-3017

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

4700 Bayou Blvd Ste 1C
Pensacola, FL 32503-2670

Mailing address

638 N Ferdon Blvd Ste 1
Crestview, FL 32536-2170
Phone (850) 331-3017

Other names 1

  • Pro Vita Physical Therapy - Pensacola Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pro Vita Physical Therapy - Florala6 organizations share this tax ID, including this one
Part of
Pro Vita Physical Therapy - Florala

Other organizations with this tax ID 5

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1881404796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "638 N FERDON BLVD STE 1",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325362170",
            "telephone_number": "850-331-3017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 BAYOU BLVD STE 1C",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032670",
            "telephone_number": "850-331-3017",
            "fax_number": "855-595-2306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO VITA PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRO VITA PHYSICAL THERAPY LLC",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-12",
        "status": "A",
        "authorized_official_last_name": "BULLA",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-331-3017",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro Vita Physical Therapy - Pensacola",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.