Healthcare Provider Details

I. General information

NPI: 1760780779
Provider Name (Legal Business Name): ORTHOPEDIC PROMPT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 CLEVELAND AVE SUITE 1
FORT MYERS FL
33901-4900
US

IV. Provider business mailing address

2531 CLEVELAND AVE SUITE 1
FORT MYERS FL
33901-4900
US

V. Phone/Fax

Practice location:
  • Phone: 239-334-7000
  • Fax: 239-334-7070
Mailing address:
  • Phone: 239-334-7000
  • Fax: 239-334-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA BRADLEY-GUENTHER
Title or Position: DIRECTOR OF CLINICAL INFORMATION
Credential:
Phone: 239-461-3691