Healthcare Provider Details

I. General information

NPI: 1770823304
Provider Name (Legal Business Name): ONCOLOGY AND ORTHOPEDIC PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 TRAIL BLVD SUITE 107
NAPLES FL
34108-2856
US

IV. Provider business mailing address

8805 TAMIAMI TRL N SUITE 211
NAPLES FL
34108-2525
US

V. Phone/Fax

Practice location:
  • Phone: 239-278-1155
  • Fax: 239-278-1159
Mailing address:
  • Phone: 239-278-1155
  • Fax: 239-278-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT23764
License Number StateFL

VIII. Authorized Official

Name: MARY KAYE RUETH
Title or Position: OWNER
Credential: PT
Phone: 239-278-1155