Healthcare Provider Details

I. General information

NPI: 1730003484
Provider Name (Legal Business Name): SEA TURTLE PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 WICKER WAY
DAYTONA BEACH FL
32117-4592
US

IV. Provider business mailing address

1141 WICKER WAY
DAYTONA BEACH FL
32117-4592
US

V. Phone/Fax

Practice location:
  • Phone: 754-779-9730
  • Fax:
Mailing address:
  • Phone: 754-779-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: DIANA C ANZOLA
Title or Position: PHYSICAL THERAPY ASSISTANT
Credential: ANZOLA
Phone: 754-779-9730