Healthcare Provider Details

I. General information

NPI: 1548407521
Provider Name (Legal Business Name): SAINT AUGUSTINE REHABILITATION SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 904-217-4259
  • Fax: 904-217-4251
Mailing address:
  • Phone: 904-217-4259
  • Fax: 904-217-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22437
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberPT22437
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID LOMAGLIO
Title or Position: OWNER
Credential: P.T.
Phone: 904-217-4259