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General NPI Number Information
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NPI Number | 1811163181
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Entity Type | Individual
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Provider Name | ROBERT LANGSTON TUGWELL P.T.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 160 S BEACH ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4408
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Country | US
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Telephone | 386-295-0753
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Fax |
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Provider Business Mailing Address
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Address Line | 15 IVEY LN
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-4935
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Country | US
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Telephone | 386-517-0025
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 19739
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License Number State | FL
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