Organization
ELDER ATHLETE PHYSICAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCIE MARIE STAGG DPT (OWNER)
(727) 380-4887
Entity
Organization
Contact information
Practice address
490 1ST AVE S STE 220, ST PETERSBURG, FL 33701-4287
(727) 380-4887
(727) 290-4328
Mailing address
400 4TH AVE S APT 106, ST PETERSBURG, FL 33701-4621
(727) 380-4887
(727) 290-4328
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
02/10/2022
Last updated
02/10/2022
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