Provider Demographics
NPI:1801687538
Name:LI, VICKI (DPT)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7296 SE SEAGATE LN
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-2161
Mailing Address - Country:US
Mailing Address - Phone:772-285-3177
Mailing Address - Fax:
Practice Address - Street 1:1400 SE GOLDTREE DR STE 205
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7583
Practice Address - Country:US
Practice Address - Phone:772-335-7966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist