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General NPI Number Information
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NPI Number | 1285104828
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Entity Type | Organization
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Legal Business Name | PEACE RIVER PHYSICAL THERAPY & REHABILITATION, LLC
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 2200 KINGS HWY UNIT 2F
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-5760
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Country | US
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Telephone | 941-888-4561
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Fax | 941-347-4695
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Provider Business Mailing Address
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Address Line | PO BOX 510326
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City | PUNTA GORDA
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State | FL
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Zip | 33951-0326
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Country | US
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Telephone | 941-888-4561
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Fax |
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Authorized Official
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Title or Position | AMBR
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Name | LANCE D DOEBLE
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Credential | MSPT
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Telephone | 941-888-4561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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