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General NPI Number Information
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NPI Number | 1619926292
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Entity Type | Organization
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Legal Business Name | PARAGON PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 3920 BEE RIDGE RD BUILDING E, SUITE H
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City | SARASOTA
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State | FL
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Zip | 34233-1207
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Country | US
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Telephone | 941-924-4605
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Fax | 941-924-4617
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Provider Business Mailing Address
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Address Line | 6015 44TH CT E
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City | BRADENTON
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State | FL
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Zip | 34203-7022
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Country | US
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Telephone | 941-321-3397
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Fax | 941-739-6028
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONNABELLE BERTULFO VITUG
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Credential | RPT
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Telephone | 94132313397
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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 | 0009493
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License Number State | FL
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