Provider Demographics
NPI:1033969902
Name:LUTHERAN HAVEN THERAPY LLC
Entity Type:Organization
Organization Name:LUTHERAN HAVEN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THERAPY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:407-706-1271
Mailing Address - Street 1:2041 W STATE ROAD 426
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8548
Mailing Address - Country:US
Mailing Address - Phone:407-706-1270
Mailing Address - Fax:407-604-4495
Practice Address - Street 1:2041 W STATE ROAD 426
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8548
Practice Address - Country:US
Practice Address - Phone:407-706-1270
Practice Address - Fax:407-604-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy