Healthcare Provider Details

I. General information

NPI: 1437096047
Provider Name (Legal Business Name): LONGEVITY REHAB & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3153 CAPISTRANO LN
NAPLES FL
34114-9799
US

IV. Provider business mailing address

3153 CAPISTRANO LN
NAPLES FL
34114-9799
US

V. Phone/Fax

Practice location:
  • Phone: 631-278-0665
  • Fax:
Mailing address:
  • Phone: 631-278-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY WAYNE CIOLINO
Title or Position: MANAGING PARTNER
Credential: OTR
Phone: 631-278-0665