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General NPI Number Information
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NPI Number | 1063869808
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPY INTENSIVES LLC
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 9330 SUMMER PL
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City | NAPLES
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State | FL
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Zip | 34109-1517
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Country | US
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Telephone | 239-571-7309
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Fax |
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Provider Business Mailing Address
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Address Line | 2338 IMMOKALEE RD # 187
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City | NAPLES
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State | FL
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Zip | 34110-1445
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Country | US
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Telephone | 239-571-7309
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Fax | 866-506-9679
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Authorized Official
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Title or Position | OWNER
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Name | JANICE JUSTIZ
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Credential | PT
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Telephone | 239-571-7309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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