Organization · NPI-2

Impression Home Healthcare & Therapy

Clinic/Center, Physical Therapy · Fort Pierce, FL

NPI number1508539586

StatusActive

Last updated in NPPESAug 10, 2022

Details

NPI: 1508539586
Entity type: Organization (NPI-2)
Legal business name: Impression Home Healthcare & Therapy
Organization subpart: No
Enumeration date: Jul 27, 2021
Certification date: Aug 10, 2022
Last updated: Aug 10, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261QP2000X	Clinic/Center, Physical Therapy	–	–	Yes
261QD1600X	Clinic/Center, Developmental Disabilities	–	–
261QR0400X	Clinic/Center, Rehabilitation	–	–
261QX0100X	Clinic/Center, Occupational Medicine	–	–
252Y00000X	Early Intervention Provider Agency	–	–
235Z00000X	Speech-Language Pathologist,	–	–
251B00000X	Case Management	–	–
251K00000X	Public Health or Welfare	–	–
208100000X	Physical Medicine & Rehabilitation	–	–
2081P0010X	Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine	–	–
2081S0010X	Physical Medicine & Rehabilitation, Sports Medicine	–	–
225700000X	Massage Therapist	–	–

Practice location

1701 N 14th St
Fort Pierce, FL 34950-2113

Phone 561-206-2289

Mailing address

6258 Wauconda Way W
Lake Worth, FL 33463-5870

Phone 561-860-1339

Other practice locations

6258 Wauconda Way W
Lake Worth, FL 33463-5870

Phone 561-860-1339

Authorized official

Roseguene Stephen
Managing Director
5618601339

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