Healthcare Provider Details

I. General information

NPI: 1922649151
Provider Name (Legal Business Name): CHEST PT 101, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2019
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OLD HIGHWAY 37 STE 103
LAKELAND FL
33813-2031
US

IV. Provider business mailing address

4745 OLD HIGHWAY 37 STE 103
LAKELAND FL
33813-2031
US

V. Phone/Fax

Practice location:
  • Phone: 833-327-8101
  • Fax: 833-327-8101
Mailing address:
  • Phone: 833-327-8101
  • Fax: 833-327-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279P1006X
TaxonomyPulmonary Function Technologist Registered Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: TAMIKA L GRUBBS
Title or Position: DON
Credential: RN
Phone: 407-730-0795