Healthcare Provider Details

I. General information

NPI: 1942789235
Provider Name (Legal Business Name): FUNCTION PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8595 COLLIER BLVD STE 115
NAPLES FL
34114-3556
US

IV. Provider business mailing address

8595 COLLIER BLVD STE 115
NAPLES FL
34114-3556
US

V. Phone/Fax

Practice location:
  • Phone: 239-228-7473
  • Fax: 239-228-7483
Mailing address:
  • Phone: 239-228-7473
  • Fax: 239-228-7483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT25476
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT25476
License Number StateFL

VIII. Authorized Official

Name: YUSI SANCHEZ
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 239-272-2101