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General NPI Number Information
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NPI Number | 1598174328
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Entity Type | Individual
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Provider Name | ELIA MYA LEXINE LPTA, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 1401 WEST SEMINOLE BLVD
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City | SANFORD
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State | FL
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Zip | 32771
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Country | US
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Telephone | 407-321-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 106 NORTH 20TH STREET
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City | FORT PIERCE
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State | FL
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Zip | 34950
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Country | US
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Telephone | 772-882-2566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA22753
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | BOC2000017708
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License Number State |
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