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General NPI Number Information
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NPI Number | 1073898227
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Entity Type | Organization
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Legal Business Name | OA CENTERS OF FLORIDA, LLC.
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 29 BARKLEY CIR
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City | FORT MYERS
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State | FL
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Zip | 33907-7531
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Country | US
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Telephone | 239-791-8173
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Fax | 239-791-8256
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Provider Business Mailing Address
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Address Line | 29 BARKLEY CIR
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City | FORT MYERS
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State | FL
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Zip | 33907-7531
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Country | US
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Telephone | 239-791-8173
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Fax | 239-791-8256
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Authorized Official
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Title or Position | DESIGNATED PRINCIPAL
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Name | MR. WILLIAM E. COLLINS
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Credential |
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Telephone | 336-399-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME0040553
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License Number State | FL
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