Provider Demographics
NPI:1104522879
Name:LADOUCEUR, STERNSON A (PT, DPT)
Entity type:Individual
Prefix:
First Name:STERNSON
Middle Name:A
Last Name:LADOUCEUR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-2227
Mailing Address - Country:US
Mailing Address - Phone:239-258-7288
Mailing Address - Fax:
Practice Address - Street 1:11930 FAIRWAY LAKES DR STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8388
Practice Address - Country:US
Practice Address - Phone:239-687-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist