Healthcare Provider Details

I. General information

NPI: 1558272716
Provider Name (Legal Business Name): PRIVIA MEDICAL GROUP FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7332 OFFICE PARK PL STE 103
MELBOURNE FL
32940-8241
US

IV. Provider business mailing address

7332 OFFICE PARK PL STE 103
MELBOURNE FL
32940-8241
US

V. Phone/Fax

Practice location:
  • Phone: 321-327-9788
  • Fax: 833-963-2359
Mailing address:
  • Phone: 321-327-9788
  • Fax: 833-963-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: LORA MORSE
Title or Position: VP, RCM
Credential:
Phone: 321-419-7360