NPIMap

Organization Active NPI

Lake Mary Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Sanford, FL
National Provider Identifier
1316089568
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT1410 Issued in FL
Legal business name
LAKE MARY PHYSICAL THERAPY, INC.
Practice address
820 W Lake Mary Blvd
Suite 102
Sanford, FL 32773-5946
Phone
(407) 321-6644
Fax
(407) 321-7309
NPI assigned
Feb 13, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gary James Piacentine, P.T.NPI 1316030174
Title
President
Phone
(407) 321-6644

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT1410 FL Primary

Addresses

Primary practice location

820 W Lake Mary Blvd
Suite 102
Sanford, FL 32773-5946

Mailing address

820 W Lake Mary Blvd
Suite 102
Sanford, FL 32773-5946
Phone (407) 321-6644

Other identifiers 1

IdentifierTypeStateIssuer
Y922POtherFLBCBS PROVIDER NUMBER

National Provider Directory

National Provider Directory

Locations

820 W Lake Mary Blvd
Ste 102
Sanford, FL 32773
Phone (407) 321-6644

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316089568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 W LAKE MARY BLVD",
            "address_2": "SUITE 102",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327735946",
            "telephone_number": "407-321-6644",
            "fax_number": "407-321-7309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 W LAKE MARY BLVD",
            "address_2": "SUITE 102",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327735946",
            "telephone_number": "407-321-6644",
            "fax_number": "407-321-7309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MARY PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PIACENTINE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-321-6644",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "PT1410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "Y922P",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sanford, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.