Healthcare Provider Details

I. General information

NPI: 1659716975
Provider Name (Legal Business Name): LEE COUNTY PHYSICAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 DIAMOND CENTRE CT SUITE 1003
FORT MYERS FL
33912-4368
US

IV. Provider business mailing address

6150 DIAMOND CENTRE CT SUITE 1003
FORT MYERS FL
33912-4368
US

V. Phone/Fax

Practice location:
  • Phone: 239-245-7909
  • Fax: 239-245-7981
Mailing address:
  • Phone: 239-245-7909
  • Fax: 239-245-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME100125
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberME100125
License Number StateFL

VIII. Authorized Official

Name: MICHAEL A LAMPE
Title or Position: OWNER
Credential:
Phone: 239-245-7909