Healthcare Provider Details

I. General information

NPI: 1386579258
Provider Name (Legal Business Name): MYO RESET PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 COCKLESHELL CT STE 12
BONITA SPRINGS FL
34135-7905
US

IV. Provider business mailing address

9211 COCKLESHELL CT STE 12
BONITA SPRINGS FL
34135-7905
US

V. Phone/Fax

Practice location:
  • Phone: 239-734-1314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW TUMBARELLO
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 239-734-1314