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General NPI Number Information
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NPI Number | 1851585707
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Entity Type | Organization
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Legal Business Name | DIZZINESS & BALANCE CENTER OF SOUTHWEST FLORIDA PA
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 3820 COLONIAL BLVD SUITE 103
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City | FORT MYERS
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State | FL
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Zip | 33966-1094
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Country | US
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Telephone | 223-943-3177
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Fax |
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Provider Business Mailing Address
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Address Line | 3820 COLONIAL BLVD SUITE 103
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City | FORT MYERS
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State | FL
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Zip | 33966-1094
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Country | US
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Telephone | 239-433-1777
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Fax | 239-433-1776
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHELLA J LOBIANCO
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Credential | MSPT
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Telephone | 239-433-1777
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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 | 23052
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License Number State | FL
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