Provider Demographics
NPI:1235596503
Name:HAVEN CARE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:HAVEN CARE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:H
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-513-9054
Mailing Address - Street 1:5634 HILLVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3246
Mailing Address - Country:US
Mailing Address - Phone:863-513-9054
Mailing Address - Fax:863-583-0390
Practice Address - Street 1:2225 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3634
Practice Address - Country:US
Practice Address - Phone:863-513-9054
Practice Address - Fax:863-583-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16870261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy