Healthcare Provider Details

I. General information

NPI: 1558315663
Provider Name (Legal Business Name): MEDICAL & SPORTS REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 GOODLETTE RD N STE 101
NAPLES FL
34102-5609
US

IV. Provider business mailing address

689 TAMIAMI TRL N STE E
NAPLES FL
34102-8100
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-4592
  • Fax: 239-261-0716
Mailing address:
  • Phone: 239-261-0291
  • Fax: 239-261-0678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: BETH YURKOVAC
Title or Position: MANAGER
Credential:
Phone: 239-261-0291