Healthcare Provider Details

I. General information

NPI: 1649035114
Provider Name (Legal Business Name): ANGELA MENCARELLI RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16251 N CLEVELAND AVE STE 3
NORTH FORT MYERS FL
33903-2176
US

IV. Provider business mailing address

16251 N CLEVELAND AVE STE 3
NORTH FORT MYERS FL
33903-2176
US

V. Phone/Fax

Practice location:
  • Phone: 239-731-6222
  • Fax: 239-731-6555
Mailing address:
  • Phone: 239-731-6222
  • Fax: 239-731-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT16776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: