Provider Demographics
NPI:1407001712
Name:REGENCY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:REGENCY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:COUTURE
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:772-283-9885
Mailing Address - Street 1:2454 SE FEDERAL HWY.
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-283-9885
Mailing Address - Fax:772-223-8781
Practice Address - Street 1:2454 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-283-9885
Practice Address - Fax:772-223-8781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENCY PHYSICAL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-01
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6470273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit