1871542217 NPI number — SOUTHWEST ORTHOPEDIC & SPORTS PHYSICAL THERAPY

Table of content: (NPI 1871542217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871542217 NPI number — SOUTHWEST ORTHOPEDIC & SPORTS PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
S O S PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871542217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 E OLYMPIA AVE
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
PUNTA GORDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33950-3833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-255-5940
Provider Business Mailing Address Fax Number:
941-255-5943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 E OLYMPIA AVE
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
PUNTA GORDA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33950-3833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-255-5940
Provider Business Practice Location Address Fax Number:
941-255-5943
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
941-255-5940

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT3524 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT2914 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: QK8 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: R6V . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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