1033257670 NPI number — FLORIDA WEST COAST PHYSICAL THERAPY & REHABILITATION CENTER INC

Table of content: (NPI 1033257670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033257670 NPI number — FLORIDA WEST COAST PHYSICAL THERAPY & REHABILITATION CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA WEST COAST PHYSICAL THERAPY & REHABILITATION CENTER INC
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:
Provider Other Organization Name Type Code:
6
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:
1033257670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
256 NOKOMIS AVE S
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34285-2357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-484-1939
Provider Business Mailing Address Fax Number:
941-484-7804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
256 NOKOMIS AVE S
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
VENICE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34285-2357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-484-1939
Provider Business Practice Location Address Fax Number:
941-484-7804
Provider Enumeration Date:
02/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
GREG
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER ADMINISTRATOR
Authorized Official Telephone Number:
941-484-1939

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  261QP2000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0560932 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 154014858 . This is a "TRICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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