Healthcare Provider Details

I. General information

NPI: 1407001712
Provider Name (Legal Business Name): REGENCY PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 SE FEDERAL HWY
STUART FL
34994
US

IV. Provider business mailing address

2454 SE FEDERAL HWY.
STUART FL
34994
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-9885
  • Fax: 772-223-8781
Mailing address:
  • Phone: 772-283-9885
  • Fax: 772-223-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberPT6470
License Number StateFL

VIII. Authorized Official

Name: MRS. LESLIE COUTURE LEVY
Title or Position: MEMBER
Credential: PT
Phone: 772-283-9885