Provider Demographics
NPI:1285138891
Name:NEUROPLASTICITY VENTURES LLC
Entity type:Organization
Organization Name:NEUROPLASTICITY VENTURES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUSEBOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-424-4240
Mailing Address - Street 1:10650 W STATE ROAD 84 STE 208
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4235
Mailing Address - Country:US
Mailing Address - Phone:954-424-4240
Mailing Address - Fax:
Practice Address - Street 1:10650 W STATE ROAD 84 STE 208
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4235
Practice Address - Country:US
Practice Address - Phone:954-424-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy