SHINE-PEDIATRIC THERAPY CENTER
NPI 1932843109
Clinic/Center in Niceville, FL
- Organization
- Clinic/Center
About SHINE-PEDIATRIC THERAPY CENTER
This page provides the complete NPI Profile along with additional information for Shine-pediatric Therapy Center, a provider established in Niceville, Florida operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1932843109 assigned on April 2022. The practitioner's primary taxonomy code is 261Q00000X. The provider is registered as an organization and their NPI record was last updated March 2026. Shine-pediatric Therapy Center operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Mary A Bryce-travis Mot/l (Owner)
- NPI
- 1932843109 Verify this NPI
- Provider Name
- SHINE-PEDIATRIC THERAPY CENTER
- Entity Type
- Organization
- Location Address
- 4565 COMMERCIAL DR STE 105 NICEVILLE, FL 32578
- Location Phone
- (850) 353-2415
- Location Fax
- (850) 353-2528
- Mailing Address
- 4565 COMMERCIAL DR STE 105 NICEVILLE, FL 32578
- Mailing Phone
- (850) 353-2415
- Mailing Fax
- (850) 353-2528
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-25-2022
- Last Update Date
- 03-10-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center
- Taxonomy Code
- 261Q00000X
- Type
- Ambulatory Health Care Facilities
- Taxonomy Description
- A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | |
| 2 | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
| 3 | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
| 4 | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
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Other Providers at the Same Location
The following 12 providers are registered at the same or a nearby location.
NICEVILLE, FL 32578
NICEVILLE, FL 32578
NICEVILLE, FL 32578
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1932843109, enumerated as an "organization" on April 25, 2022.
The provider is located at 4565 COMMERCIAL DR STE 105 NICEVILLE, FL 32578 and the phone number is (850) 353-2415.
Clinic/Center with taxonomy code 261Q00000X.
