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General NPI Number Information
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NPI Number | 1295730216
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Entity Type | Organization
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Legal Business Name | AMPUTEE CLINIC, INC.
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 7051 CYPRESS TER #108
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City | FORT MYERS
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State | FL
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Zip | 33907-8822
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Country | US
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Telephone | 239-437-4010
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Fax | 239-437-4097
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Provider Business Mailing Address
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Address Line | 7051 CYPRESS TER #108
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City | FORT MYERS
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State | FL
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Zip | 33907-8822
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Country | US
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Telephone | 239-437-4010
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Fax | 239-437-4097
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Authorized Official
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Title or Position | PRESIDENT PT CP LPO
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Name | MR. MARCUM R RANDALL
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Credential | PT, CP, LPO
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Telephone | 239-437-4010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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