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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