Provider Demographics
NPI:1972967743
Name:NAU PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:NAU PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOKUNTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:772-342-1020
Mailing Address - Street 1:10023 S US HIGHWAY 1
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5643
Mailing Address - Country:US
Mailing Address - Phone:772-342-1020
Mailing Address - Fax:
Practice Address - Street 1:10023 S US HIGHWAY 1
Practice Address - Street 2:SUITE A
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5643
Practice Address - Country:US
Practice Address - Phone:772-342-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23414208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty