Healthcare Provider Details

I. General information

NPI: 1104889534
Provider Name (Legal Business Name): SYPERT INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 DEL PRADO BLVD N SUITE 101
CAPE CORAL FL
33909-2278
US

IV. Provider business mailing address

632 DEL PRADO BLVD N SUITE 101
CAPE CORAL FL
33909-2253
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-5577
  • Fax: 239-772-8879
Mailing address:
  • Phone: 239-772-5577
  • Fax: 239-772-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT O GRADY
Title or Position: VICE PRESIDENT
Credential:
Phone: 239-432-0774