Provider Demographics
NPI:1508323700
Name:CLEARWATER PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:CLEARWATER PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:727-692-5115
Mailing Address - Street 1:2878 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-1923
Mailing Address - Country:US
Mailing Address - Phone:727-692-5115
Mailing Address - Fax:813-354-4511
Practice Address - Street 1:2878 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-1923
Practice Address - Country:US
Practice Address - Phone:727-692-5115
Practice Address - Fax:813-354-4511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1235134529OtherWELLCARE
FL1235134529OtherAETNA
FL1235134529OtherTRIWEST
FL1235134529OtherHUMANA
FL1235134529OtherSIMPLY
FL1235134529Medicaid