Healthcare Provider Details

I. General information

NPI: 1538788617
Provider Name (Legal Business Name): SAINT AUGUSTINE REHABILITATION SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 LAKESIDE AVE STE 3
SAINT AUGUSTINE FL
32084-4102
US

IV. Provider business mailing address

105 MARINER HEALTH WAY STE 213
ST AUGUSTINE FL
32086-3251
US

V. Phone/Fax

Practice location:
  • Phone: 904-679-3449
  • Fax: 904-679-3436
Mailing address:
  • Phone: 904-217-4259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DAVID LOMAGLIO
Title or Position: MEMBER
Credential:
Phone: 904-217-4259