Healthcare Provider Details

I. General information

NPI: 1215982921
Provider Name (Legal Business Name): NANCY J GRESHAM P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 8TH ST N
NAPLES FL
34102-5519
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-7778
  • Fax:
Mailing address:
  • Phone: 239-254-7778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT16692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: