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General NPI Number Information
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NPI Number | 1205582723
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Entity Type | Organization
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Legal Business Name | GULF COAST KNEE SCOOTER
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 3506 BLITMAN ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33981-1301
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Country | US
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Telephone | 970-278-6718
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Fax |
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Provider Business Mailing Address
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Address Line | 3506 BLITMAN ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33981-1301
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Country | US
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Telephone | 970-278-6718
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CINDY RONCO
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Credential |
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Telephone | 970-278-6718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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