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General NPI Number Information
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NPI Number | 1811361512
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Entity Type | Organization
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Legal Business Name | LAKE PLACID REHABILITATION INC
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 145 TOWER ST
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City | LAKE PLACID
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State | FL
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Zip | 33852-6836
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Country | US
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Telephone | 863-465-9991
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Fax | 863-465-9906
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Provider Business Mailing Address
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Address Line | 145 TOWER ST
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City | LAKE PLACID
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State | FL
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Zip | 33852-6836
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Country | US
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Telephone | 863-465-9991
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Fax | 863-465-9906
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Authorized Official
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Title or Position | OWNER
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Name | LINDA S CRUSE
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Credential | DPT
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Telephone | 863-465-9991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT19782
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License Number State | FL
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