Provider Demographics
NPI:1386834638
Name:LA SALETTE HEALTH AND FITNESS INSTITUTE
Entity Type:Organization
Organization Name:LA SALETTE HEALTH AND FITNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CANO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:321-525-5453
Mailing Address - Street 1:PO BOX 33265
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-0265
Mailing Address - Country:US
Mailing Address - Phone:321-525-5453
Mailing Address - Fax:
Practice Address - Street 1:105 S RIVERSIDE DR
Practice Address - Street 2:STE # 150
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4365
Practice Address - Country:US
Practice Address - Phone:321-525-5453
Practice Address - Fax:866-810-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-11017302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5332OtherBCBS