Healthcare Provider Details

I. General information

NPI: 1588333793
Provider Name (Legal Business Name): CL6 PHYSIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 NORTHBROOKE PLAZA DR UNIT 207
NAPLES FL
34119-8099
US

IV. Provider business mailing address

2338 IMMOKALEE RD STE 203
NAPLES FL
34110-1445
US

V. Phone/Fax

Practice location:
  • Phone: 239-919-4342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MARCI CHARLAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 239-919-4342