Healthcare Provider Details

I. General information

NPI: 1114287653
Provider Name (Legal Business Name): INJURY TREATMENT CENTER OF NAPLES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 PINE RIDGE RD SUITE E
NAPLES FL
34109-2002
US

IV. Provider business mailing address

2295 NW CORPORATE BLVD SUITE 140
BOCA RATON FL
33431-7373
US

V. Phone/Fax

Practice location:
  • Phone: 239-325-2909
  • Fax: 239-325-2914
Mailing address:
  • Phone: 561-988-1022
  • Fax: 561-988-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA HERNANDEZ
Title or Position: REGIONAL MANAGER
Credential:
Phone: 561-445-4613