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General NPI Number Information
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NPI Number | 1316089568
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Entity Type | Organization
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Legal Business Name | LAKE MARY PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 820 W LAKE MARY BLVD SUITE 102
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City | SANFORD
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State | FL
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Zip | 32773-5946
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Country | US
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Telephone | 407-321-6644
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Fax | 407-321-7309
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Provider Business Mailing Address
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Address Line | 820 W LAKE MARY BLVD SUITE 102
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City | SANFORD
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State | FL
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Zip | 32773-5946
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Country | US
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Telephone | 407-321-6644
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Fax | 407-321-7309
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY JAMES PIACENTINE
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Credential | P.T.
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Telephone | 407-321-6644
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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 | PT1410
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License Number State | FL
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