Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Space Coast Medical, LLC

Organization General Practice Physician · NPI 1376807511

Space Coast Medical, LLC is a General Practice Physician in Barefoot Bay, Florida. Licensed in Florida. Registered with an NPI since 2012.

Licensed in
FL
In the registry since
2012
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

935 Barefoot Blvd Bldg 1 Ste 2
Barefoot Bay, FL 32976-7620
Phone: (321) 557-4667
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Rehabilitation Clinic/Center (primary) Taxonomy 261QR0400X
General Practice Physician Taxonomy 208D00000X · Licence OS6898 (FL)
Physical Therapy Clinic/Center Taxonomy 261QP2000X

Record details

NPI number1376807511
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jason Lail — C.E.O. · (321) 557-4667
NPI enumeratedJuly 3, 2012
Last updated in NPPESJuly 28, 2015
Mailing address4295 N Us Highway 1, Melbourne, FL 32935-4822