Provider Demographics
NPI:1669739587
Name:VANWANZEELE, LEMI SALAMANCA (PT)
Entity type:Individual
Prefix:MRS
First Name:LEMI
Middle Name:SALAMANCA
Last Name:VANWANZEELE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BAYOU BLVD S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-4433
Mailing Address - Country:US
Mailing Address - Phone:727-692-0814
Mailing Address - Fax:727-822-3019
Practice Address - Street 1:700 BAYOU BLVD S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-4433
Practice Address - Country:US
Practice Address - Phone:727-692-0814
Practice Address - Fax:727-822-3019
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist