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General NPI Number Information
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NPI Number | 1659961647
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Entity Type | Organization
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Legal Business Name | L'IMAGE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 5741 SW 109TH AVE
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City | DAVIE
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State | FL
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Zip | 33328-6303
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Country | US
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Telephone | 954-261-5625
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Fax |
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Provider Business Mailing Address
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Address Line | 5741 SW 109TH AVE
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City | DAVIE
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State | FL
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Zip | 33328-6303
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Country | US
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Telephone | 954-261-5625
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. YVELISE PETIT STANLEY
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Credential | PHYSICAL THERAPIST
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Telephone | 954-261-5625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number |
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License Number State |
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