Healthcare Provider Details

I. General information

NPI: 1356647705
Provider Name (Legal Business Name): THERAPY ONE CR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W MCKENZIE ST SUITE 118
PUNTA GORDA FL
33950-5500
US

IV. Provider business mailing address

150 W MCKENZIE ST SUITE 118
PUNTA GORDA FL
33950-5500
US

V. Phone/Fax

Practice location:
  • Phone: 941-235-7246
  • Fax:
Mailing address:
  • Phone: 941-235-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT17445
License Number StateFL

VIII. Authorized Official

Name: MR. GABRIEL A. WEBER
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: P.T.
Phone: 941-421-8380