Healthcare Provider Details

I. General information

NPI: 1720142748
Provider Name (Legal Business Name): JAMES FIUMEFREDDO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 TAMIAMI TRL STE 2
PORT CHARLOTTE FL
33952-9207
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 844-287-2286
  • Fax: 941-883-4101
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: