Provider Demographics
NPI:1255832291
Name:LW PEDS PT, LLC
Entity Type:Organization
Organization Name:LW PEDS PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERVELT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PCS, ATP
Authorized Official - Phone:321-427-3817
Mailing Address - Street 1:2900 PICKFAIR ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6829
Mailing Address - Country:US
Mailing Address - Phone:321-427-3817
Mailing Address - Fax:
Practice Address - Street 1:2900 PICKFAIR ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-6829
Practice Address - Country:US
Practice Address - Phone:321-427-3817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26434261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy