Organization
LAKE MARY PHYSICAL THERAPY, INC.
Active
Organization
LAKE MARY PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY JAMES PIACENTINE P.T. (PRESIDENT)
(407) 321-6644
Entity
Organization
Contact information
Practice address
820 W LAKE MARY BLVD, SUITE 102, SANFORD, FL 32773-5946
(407) 321-6644
(407) 321-7309
Mailing address
820 W LAKE MARY BLVD, SUITE 102, SANFORD, FL 32773-5946
(407) 321-6644
(407) 321-7309
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT1410
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y922P
BCBS PROVIDER NUMBER
FL
Enumeration date
02/13/2007
Last updated
08/22/2020
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