Provider Demographics
NPI:1366957326
Name:LVN MEDICAL OFFICE AND PHYSICAL THERAPY CORP
Entity type:Organization
Organization Name:LVN MEDICAL OFFICE AND PHYSICAL THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:YUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-803-4502
Mailing Address - Street 1:1406 SE 46TH LN STE 10
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8684
Mailing Address - Country:US
Mailing Address - Phone:239-541-9150
Mailing Address - Fax:239-541-9181
Practice Address - Street 1:1406 SE 46TH LN STE 10
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8684
Practice Address - Country:US
Practice Address - Phone:239-541-9150
Practice Address - Fax:239-541-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty