Provider Demographics
NPI:1508546557
Name:PATHWAY PT LLC
Entity Type:Organization
Organization Name:PATHWAY PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZO ACUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:786-270-6853
Mailing Address - Street 1:2888 RINGLING BLVD UNIT CD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5331
Mailing Address - Country:US
Mailing Address - Phone:786-270-6853
Mailing Address - Fax:
Practice Address - Street 1:2888 RINGLING BLVD UNIT CD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5331
Practice Address - Country:US
Practice Address - Phone:867-270-6853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty