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NPI Code Detail

MEDICARE: PHYSIONETICS LLC

MEDICARE: PHYSIONETICS LLC
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
1261QP2000XPhysical Therapy Clinic/CenterPT10624FL

General Provider Information

NPI Number : 1578878450
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSIONETICS LLC
Provider Business Mailing Address
First Line : 1575 PINE RIDGE RD STE 15
Second Line :
City : NAPLES
State : FL
Zip : 34109-2110
Country : US
Telephone Number : 239-593-4348
Fax Number : 239-593-4387
Provider Business Practice Location Address
First Line : 1575 PINE RIDGE RD STE 15
Second Line :
City : NAPLES
State : FL
Zip : 34109-2110
Country : US
Telephone Number : 239-593-4348
Fax Number : 239-593-4387
Authorized Official
Title or Position : OWNER
Name : MS. NICOLA KHALAF VARVERIS
Credential : MSPT
Telephone Number : 239-593-4348
Provider Enumeration Date : 08/16/2010
Last Update Date : 05/03/2016

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Directions to “PHYSIONETICS LLC ” Practice Location

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