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General NPI Number Information
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NPI Number | 1972967743
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Entity Type | Organization
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Legal Business Name | NAU PHYSICAL THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 10023 S US HIGHWAY 1 SUITE A
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-5643
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Country | US
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Telephone | 772-342-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 10023 S US HIGHWAY 1 SUITE A
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-5643
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Country | US
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Telephone | 772-342-1020
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SOKUNTHEA NAU
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Credential | DPT
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Telephone | 772-342-1020
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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 | PT23414
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License Number State | FL
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