Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 21687 | FL |
NPI | 1033710769 |
---|---|
Provider Name | Stephen Landreville |
First Address | Parkland, FL 33076-3356 |
Second Address | Palm City, FL 34990-2683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2020 |
Last Update Date | 09/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21687 | STATE LICENSE (01) | FL |