Healthcare Provider Details

I. General information

NPI: 1770131443
Provider Name (Legal Business Name): FYZICAL THERAPY & BALANCE CENTER ROCKLEDGE-VIERA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 BARNES BOULEVARD UNIT 202
ROCKLEDGE FL
32955
US

IV. Provider business mailing address

634 BARNES BLVD STE 202
ROCKLEDGE FL
32955-5217
US

V. Phone/Fax

Practice location:
  • Phone: 321-351-2700
  • Fax: 321-351-2727
Mailing address:
  • Phone: 321-351-2700
  • Fax: 321-351-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW WILLIAM BREMER
Title or Position: OWNER, PT, AUTHORIZED OFFICAL
Credential: DPT
Phone: 321-351-2700