Healthcare Provider Details

I. General information

NPI: 1871223479
Provider Name (Legal Business Name): CASEY GLOWICKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 VETERANS PARK DR STE 101
NAPLES FL
34109-0447
US

IV. Provider business mailing address

150 TAMIAMI TRL N
NAPLES FL
34102-6215
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-7778
  • Fax:
Mailing address:
  • Phone: 239-315-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number31515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: