Healthcare Provider Details

I. General information

NPI: 1184677288
Provider Name (Legal Business Name): GTP MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 COLLEGE PKWY SUITE 2
FT MYERS FL
33919-4882
US

IV. Provider business mailing address

15880 SUMMERLIN RD STE 300 PMB 106
FORT MYERS FL
33908-9613
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-0300
  • Fax: 239-482-4757
Mailing address:
  • Phone: 239-482-0300
  • Fax: 239-482-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH8431
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS7123
License Number StateFL

VIII. Authorized Official

Name: DR. GEORGE S PETRYK
Title or Position: PRESIDENT
Credential: DC,DACNB,FACFN,FABES
Phone: 239-482-0300