Healthcare Provider Details

I. General information

NPI: 1780299545
Provider Name (Legal Business Name): SAINT AUGUSTINE REHABILITATION SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 STRONGWAY CT STE A
SAINT AUGUSTINE FL
32086-0395
US

IV. Provider business mailing address

3930 A1A S STE 7
SAINT AUGUSTINE FL
32080-6940
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID LOMAGLIO
Title or Position: MANAGING MEMBER
Credential:
Phone: 904-679-3449