Healthcare Provider Details

I. General information

NPI: 1851098529
Provider Name (Legal Business Name): LEMON CITY COLLECTIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 NE 64TH ST
MIAMI FL
33138-6132
US

IV. Provider business mailing address

516 NE 64TH ST
MIAMI FL
33138-6132
US

V. Phone/Fax

Practice location:
  • Phone: 305-338-9138
  • Fax:
Mailing address:
  • Phone: 305-338-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY AQUART
Title or Position: EXECUTIVE DIRECTOR
Credential: DPT
Phone: 305-338-9138