is a Pediatrics in Lakeland, Florida. practices all healthcare services and medical treatments related to Pediatrics. The NPI Number for is 1740330968. The last update date is .
's current location address is 1028 Candlewood Dr, Lakeland, Florida. You can contact this provider via phone number 8632941429 and fax number 8632980299. The mailing address for is 1028 Candlewood Dr, Lakeland, Florida. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 1028 Candlewood Dr, Lakeland, Florida |
| Phone Number | 8632941429 |
| Fax Number | 8632980299 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1740330968 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 1028 Candlewood Dr |
|---|---|
| City | Lakeland |
| State | Florida (FL) |
| Post Code | 338132805 |
| Phone Number | 8632941429 |
| Fax Number | 8632980299 |
Provider's Primary Taxonomy Detail
| Speciality | Pediatrics |
|---|---|
| Taxonomy | 2251P0200X |
| Licence No | PT20199 |
|
Definition: A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Pediatric Physical Therapy, who has demonstrated specialized knowledge and skill in anatomy, histology, including embryonic development, |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 889152400 | FL | -- |
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