MEDICARE: STERNSON A LADOUCEUR PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT39916	FL

General Provider Information

NPI Number	:	1104522879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STERNSON A LADOUCEUR PT, DPT

Provider Business Mailing Address
First Line	:	112 IRVING AVE
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-2227
Country	:	US
Telephone Number	:	239-258-7288
Fax Number	:

Provider Business Practice Location Address
First Line	:	11930 FAIRWAY LAKES DR STE 103
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-8388
Country	:	US
Telephone Number	:	239-687-3224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	02/03/2023

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