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General NPI Number Information
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NPI Number | 1144538372
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Entity Type | Organization
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Legal Business Name | AGILITY REHABILITATION AND WELLNESS, LLC
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 5997 CORAL WAY
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City | BRADENTON
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State | FL
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Zip | 34207-4720
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Country | US
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Telephone | 941-751-3621
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Fax |
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Provider Business Mailing Address
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Address Line | 5997 CORAL WAY
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City | BRADENTON
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State | FL
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Zip | 34207-4720
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Country | US
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Telephone | 941-751-3621
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | STEVEN LAMANIA
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Credential | COTA
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Telephone | 941-751-3621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT12569
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA9578
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT16707
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License Number State | FL
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