Healthcare Provider Details

I. General information

NPI: 1871723585
Provider Name (Legal Business Name): KELLY ANN BEBBER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13691 METRO PKWY SUITE 400
FORT MYERS FL
33912-4327
US

IV. Provider business mailing address

13691 METRO PKWY SUITE 400
FORT MYERS FL
33912-4327
US

V. Phone/Fax

Practice location:
  • Phone: 239-768-2272
  • Fax: 239-768-5794
Mailing address:
  • Phone: 239-768-2272
  • Fax: 239-768-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: