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General NPI Number Information
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NPI Number | 1184854929
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Entity Type | Organization
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Legal Business Name | LAKESIDE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 404 E FRONT ST
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City | LAUREL
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State | DE
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Zip | 19956-1741
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Country | US
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Telephone | 302-280-6920
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Fax | 302-280-6921
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Provider Business Mailing Address
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Address Line | 404 E FRONT ST
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City | LAUREL
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State | DE
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Zip | 19956-1741
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Country | US
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Telephone | 302-280-6920
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Fax | 302-280-6921
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Authorized Official
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Title or Position | OWNER
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Name | MR. METODIO AMAHIT PAMPLONA JR.
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Credential | P.T.
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Telephone | 302-280-6920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2009603216
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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