Healthcare Provider Details

I. General information

NPI: 1073432647
Provider Name (Legal Business Name): MIKITA HELLIE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 GRADUATE CT
LEHIGH ACRES FL
33971-2049
US

IV. Provider business mailing address

1500 GRADUATE CT
LEHIGH ACRES FL
33971-2049
US

V. Phone/Fax

Practice location:
  • Phone: 509-939-8181
  • Fax:
Mailing address:
  • Phone: 509-939-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: