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General NPI Number Information
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NPI Number | 1962574541
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Entity Type | Organization
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Legal Business Name | BOLLETTIERI SPORTS MEDICINE CENTER
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 5500 34TH STREET WEST
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City | BRADENTON
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State | FL
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Zip | 34210-3506
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Country | US
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Telephone | 941-755-0068
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Fax | 941-727-7502
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Provider Business Mailing Address
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Address Line | 5500 34TH STREET WEST
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City | BRADENTON
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State | FL
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Zip | 34210-3506
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Country | US
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Telephone | 941-755-0068
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Fax | 941-727-7502
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JAY S FRYE
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Credential | PT
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Telephone | 941-755-0068
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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 |
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License Number State |
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