Provider Demographics
NPI:1427173640
Name:ADVANCED PHYSICAL THERAPY OF LAKE COUNTY, INC.
Entity type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY OF LAKE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MONERT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:352-735-8543
Mailing Address - Street 1:3800 LAKE CENTER DR STE B3
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2208
Mailing Address - Country:US
Mailing Address - Phone:352-735-8543
Mailing Address - Fax:352-735-8551
Practice Address - Street 1:3800 LAKE CENTER DR STE B3
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2208
Practice Address - Country:US
Practice Address - Phone:352-735-8543
Practice Address - Fax:352-735-8551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17889261QP2000X
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL829437OtherACN GROUP - DENISE MONERT
FL887503100Medicaid
FL681950OtherACN GROUP - S. HOUSTOUN
FL7830261OtherAETNA PROVIDER ID
FL=========OtherHUMANA GROUP
FL887503100Medicaid
FLU0593AMedicare ID - Type UnspecifiedSHANNON HOUSTOUN
FL681950OtherACN GROUP - S. HOUSTOUN
FL829437OtherACN GROUP - DENISE MONERT