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General NPI Number Information
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NPI Number | 1598850620
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Entity Type | Organization
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Legal Business Name | S.W. FLORIDA PROSTHETIC CLINIC, INC.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 13691 METRO PARKWAY SUITE 100
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City | FT. MYERS
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State | FL
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Zip | 33912
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Country | US
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Telephone | 239-936-0033
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Fax | 239-936-0047
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Provider Business Mailing Address
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Address Line | 13691 METRO PARKWAY SUITE 100
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City | FT. MYERS
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State | FL
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Zip | 33912
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Country | US
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Telephone | 239-936-0033
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Fax | 239-936-0047
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Authorized Official
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Title or Position | BOARD CERTIFIED ANAPLASTOLOGIST
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Name | GREGORY T. ANERINO
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Credential |
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Telephone | 239-936-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State | FL
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