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General NPI Number Information
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NPI Number | 1255832291
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Entity Type | Organization
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Legal Business Name | LW PEDS PT, LLC
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 02/26/2018
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Provider Practice Location Address
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Address Line | 2900 PICKFAIR ST
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City | ORLANDO
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State | FL
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Zip | 32803-6829
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Country | US
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Telephone | 321-427-3817
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 PICKFAIR ST
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City | ORLANDO
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State | FL
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Zip | 32803-6829
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Country | US
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Telephone | 321-427-3817
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. LINDLEY WESTERVELT
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Credential | PT, PCS, ATP
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Telephone | 321-427-3817
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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 | PT26434
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License Number State | FL
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