Organization
PRO VITA PHYSICAL THERAPY LLC
Active
Parent organization
PRO VITA PHYSICAL THERAPY, LLC
Other names
Pro Vita Physical Therapy - Navarre
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRO VITA PHYSICAL THERAPY, LLC
Authorized official
CARLA J BULLA (OWNER)
(850) 902-7315
Entity
Organization
Contact information
Practice address
1987 HIGHWAY 87, NAVARRE, FL 32566-1046
(850) 710-7163
(855) 975-2471
Mailing address
638 N FERDON BLVD STE 1, CRESTVIEW, FL 32536-2170
(850) 710-7163
(855) 975-2471
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S0MOA
FLORIDA BLUE
FL
Enumeration date
07/29/2021
Last updated
08/29/2022
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