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General NPI Number Information
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NPI Number | 1386834638
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Entity Type | Organization
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Legal Business Name | LA SALETTE HEALTH AND FITNESS INSTITUTE
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 105 S RIVERSIDE DR STE # 150
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City | INDIALANTIC
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State | FL
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Zip | 32903-4365
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Country | US
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Telephone | 321-525-5453
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Fax | 866-810-9307
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Provider Business Mailing Address
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Address Line | PO BOX 33265
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City | INDIALANTIC
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State | FL
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Zip | 32903-0265
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Country | US
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Telephone | 321-525-5453
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MS. MARIANNE S CANO
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Credential | M.S.P.T.
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Telephone | 321-525-5453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | PT-11017
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License Number State | FL
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