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General NPI Number Information
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NPI Number | 1730069766
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Entity Type | Organization
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Legal Business Name | A.G.E. REHABILITATION & WELLNESS, LLC
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 540 TRINITY LN N APT 4209
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City | SAINT PETERSBURG
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State | FL
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Zip | 33716-1319
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Country | US
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Telephone | 334-398-1128
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Fax |
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Provider Business Mailing Address
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Address Line | 540 TRINITY LN N APT 4209
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City | SAINT PETERSBURG
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State | FL
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Zip | 33716-1319
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERALESHA BAITY
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Credential |
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Telephone | 334-398-1128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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