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General NPI Number Information
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NPI Number | 1194600957
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Entity Type | Individual
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Provider Name | LEAH DANIELLE BOMBASSARO PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/09/2025
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Last Update Date | 08/09/2025
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Provider Practice Location Address
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Address Line | 12820 KENWOOD LN STE 5
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City | FORT MYERS
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State | FL
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Zip | 33907-5617
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Country | US
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Telephone | 239-690-6768
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Fax |
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Provider Business Mailing Address
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Address Line | 3771 LITTLE CREEK DR
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City | FORT MYERS
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State | FL
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Zip | 33905-6406
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Country | US
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Telephone | 239-223-9562
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Fax |
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT43513
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License Number State | FL
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