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General NPI Number Information
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NPI Number | 1093948135
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Entity Type | Organization
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Legal Business Name | LIVING LARGE THERAPEUTICS LLC
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 718 KANUGA DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-7222
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Country | US
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Telephone | 561-762-3105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1311
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City | WEST PALM BEACH
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State | FL
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Zip | 33402-1311
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Country | US
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Telephone | 561-762-3105
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Fax |
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Authorized Official
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Title or Position | P.T.
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Name | MRS. EMILY LARGE
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Credential | P.T.
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Telephone | 561-762-3105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT19954
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License Number State | FL
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