=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821014069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APEX PHYSICAL THERAPY OF SOUTHWEST FLORIDA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15751 SAN CARLOS BLVD SUITE #4
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-337-2739
-----------------------------------------------------
Fax | 239-337-2738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15751 SAN CARLOS BLVD SUITE #4
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-337-2739
-----------------------------------------------------
Fax | 239-337-2738
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / PHYSICAL THERAPIST
-----------------------------------------------------
Name | MRS. ANGELA CAROL MCGILVREY
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 239-337-2739
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 057304
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------