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General NPI Number Information
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NPI Number | 1861612830
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Entity Type | Organization
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Legal Business Name | LAKEVIEW IDD THERAPY CENTER P.A.
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3750 EMERGENCY LANE SUITE 1
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City | SEBRING
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State | FL
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Zip | 33870
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Country | US
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Telephone | 863-471-1511
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Fax | 863-471-1512
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Provider Business Mailing Address
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Address Line | 3750 EMERGENCY LANE SUITE 1
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City | SEBRING
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State | FL
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Zip | 33870
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Country | US
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Telephone | 863-471-1511
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Fax | 863-471-1512
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Authorized Official
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Title or Position | OWNER
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Name | JOSE R THOMAS RICHARDS
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Credential | D.O.
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Telephone | 863-471-1511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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