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General NPI Number Information
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NPI Number | 1053196568
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Entity Type | Organization
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Legal Business Name | PRO VITA PHYSICAL THERAPY - FLORALA
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 804 ELM ST
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City | FLORALA
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State | AL
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Zip | 36442-3560
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Country | US
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Telephone | 850-331-3017
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Fax | 855-275-6191
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Provider Business Mailing Address
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Address Line | 638 N FERDON BLVD STE 1
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City | CRESTVIEW
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State | FL
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Zip | 32536-2170
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Country | US
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Telephone | 850-331-3017
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Fax | 855-275-2575
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Authorized Official
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Title or Position | CEO
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Name | CARLA J BULLA
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Credential |
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Telephone | 850-331-3017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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