Healthcare Provider Details

I. General information

NPI: 1972256071
Provider Name (Legal Business Name): C I T REHAB & WELNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 CLEVELAND AVE STE 205
FORT MYERS FL
33901-5850
US

IV. Provider business mailing address

2665 CLEVELAND AVE STE 205
FORT MYERS FL
33901-5850
US

V. Phone/Fax

Practice location:
  • Phone: 239-362-3314
  • Fax: 239-362-3655
Mailing address:
  • Phone: 239-362-3314
  • Fax: 239-362-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TERESA D DAMERA
Title or Position: OWNER/APRN
Credential: APRN
Phone: 239-362-3314