Provider Demographics
NPI:1730069766
Name:A.G.E. REHABILITATION & WELLNESS, LLC
Entity type:Organization
Organization Name:A.G.E. REHABILITATION & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERALESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-398-1128
Mailing Address - Street 1:540 TRINITY LN N APT 4209
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 TRINITY LN N APT 4209
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1319
Practice Address - Country:US
Practice Address - Phone:334-398-1128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty