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General NPI Number Information
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NPI Number | 1639513518
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Entity Type | Organization
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Legal Business Name | LAUREL PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 433 N CAUSEWAY
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City | NEW SMYRNA
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State | FL
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Zip | 32169-5266
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Country | US
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Telephone | 386-679-5471
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Fax |
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Provider Business Mailing Address
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Address Line | 116 CANAL ST STE D
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City | NEW SMYRNA
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State | FL
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Zip | 32168-7076
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/DIRECTOR
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Name | CAROL WEIGHTMAN
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Credential |
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Telephone | 386-426-8327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | P1300025007
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License Number State |
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