MEDICARE: AUDREY PARKER TOLBERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA22661	FL

General Provider Information

NPI Number	:	1134884802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY PARKER TOLBERT

Provider Business Mailing Address
First Line	:	2059 ALTAMONT AVE STE 105
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3281
Country	:	US
Telephone Number	:	239-400-5639
Fax Number	:

Provider Business Practice Location Address
First Line	:	2059 ALTAMONT AVE STE 105
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3281
Country	:	US
Telephone Number	:	239-400-5639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2021
Last Update Date	:	11/07/2021

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Directions to “ AUDREY PARKER TOLBERT ” Practice Location

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