Healthcare Provider Details

I. General information

NPI: 1144538372
Provider Name (Legal Business Name): AGILITY REHABILITATION AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5997 CORAL WAY
BRADENTON FL
34207-4720
US

IV. Provider business mailing address

5997 CORAL WAY
BRADENTON FL
34207-4720
US

V. Phone/Fax

Practice location:
  • Phone: 941-751-3621
  • Fax:
Mailing address:
  • Phone: 941-751-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA9578
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT16707
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT12569
License Number StateFL

VIII. Authorized Official

Name: STEVEN LAMANIA
Title or Position: MANAGING MEMBER
Credential: COTA
Phone: 941-751-3621