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General NPI Number Information
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NPI Number | 1639590078
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Entity Type | Organization
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Legal Business Name | BIG PINE PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 133 PALOMINO HORSE TRL
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City | BIG PINE KEY
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State | FL
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Zip | 33043-3359
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Country | US
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Telephone | 305-304-4585
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Fax |
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Provider Business Mailing Address
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Address Line | 133 PALOMINO HORSE TRL
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City | BIG PINE KEY
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State | FL
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Zip | 33043-3359
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Country | US
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Telephone | 305-304-4585
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. RODGER ALEX GLEN EVANS
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Credential | DPT
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Telephone | 305-304-4585
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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 | 25901
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License Number State | FL
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