Organization
SELECT PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY WIEMER (VICE PRESIDENT)
(727) 771-7377
Entity
Organization
Contact information
Practice address
3317 US HIGHWAY 98 S STE 6, LAKELAND, FL 33803-8316
(863) 667-3092
Mailing address
3317 US HIGHWAY 98 S STE 6, LAKELAND, FL 33803-8316
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
27400
FL
Other
Enumeration date
12/05/2012
Last updated
12/05/2012
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