=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396779179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYONNE PHYSICAL THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9200 BONITA BEACH ROAD SUITE 103
-----------------------------------------------------
City | BONITA SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34135-4277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-949-9599
-----------------------------------------------------
Fax | 239-947-9347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5263 GOLDEN GATE PKWY UNITE E
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34116-7601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-352-9884
-----------------------------------------------------
Fax | 239-352-8610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. DIANNE CORTESE
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 239-352-9884
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 042638
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------