=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336687292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORRECTIVE THERAPY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2017
-----------------------------------------------------
Last Update Date | 02/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3135 STATE ROAD 580 SUITE 11
-----------------------------------------------------
City | SAFETY HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34695-4976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-481-3301
-----------------------------------------------------
Fax | 727-812-2737
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3135 STATE ROAD 580 SUITE 11
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34695-4976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-481-3301
-----------------------------------------------------
Fax | 727-812-2737
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. FRANK PUGNI
-----------------------------------------------------
Credential | LMT, PTA
-----------------------------------------------------
Telephone | 727-481-3301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | LMT26201
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------