Provider Demographics
NPI:1639474547
Name:LYMPHEDEMA AND PHYSICAL THERAPY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:LYMPHEDEMA AND PHYSICAL THERAPY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HUYEN
Authorized Official - Middle Name:LU
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:321-356-6460
Mailing Address - Street 1:3390 PLAYERS POINT LOOP
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-4771
Mailing Address - Country:US
Mailing Address - Phone:321-356-6460
Mailing Address - Fax:407-889-4507
Practice Address - Street 1:301 N HIGHWAY 27
Practice Address - Street 2:SUITE F
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2447
Practice Address - Country:US
Practice Address - Phone:352-432-3910
Practice Address - Fax:352-432-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21120261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy