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General NPI Number Information
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NPI Number | 1104919935
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Entity Type | Individual
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Provider Name | TRINA JANE PUDDEFOOT DSC. PT
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 12220 TOWNE LAKE DR STE 1
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City | FORT MYERS
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State | FL
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Zip | 33913-8021
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Country | US
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Telephone | 239-433-6700
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Fax | 239-433-6703
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Provider Business Mailing Address
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Address Line | 12220 TOWNE LAKE DR STE 1
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City | FORT MYERS
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State | FL
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Zip | 33913-8021
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Country | US
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Telephone | 239-910-5199
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Fax | 239-433-6703
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 21360
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License Number State | FL
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