Organization
LAKESIDE PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. METODIO AMAHIT PAMPLONA JR. P.T. (OWNER)
(302) 280-6920
Entity
Organization
Contact information
Practice address
404 E FRONT ST, LAUREL, DE 19956-1741
(302) 280-6920
(302) 280-6921
Mailing address
404 E FRONT ST, LAUREL, DE 19956-1741
(302) 280-6920
(302) 280-6921
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
2009603216
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548466550
NPI
DE
01
—
1548494297
NPI
DE
Enumeration date
07/14/2009
Last updated
04/28/2025
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