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General NPI Number Information
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NPI Number | 1992096788
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Entity Type | Organization
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Legal Business Name | JM2GO, LLC.
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 9400 GLADIOLUS DR SUITE #60
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City | FORT MYERS
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State | FL
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Zip | 33908-6699
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Country | US
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Telephone | 239-565-8300
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Fax | 239-565-8300
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Provider Business Mailing Address
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Address Line | PO BOX 61105
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City | FORT MYERS
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State | FL
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Zip | 33906-1105
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Country | US
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Telephone | 239-565-8300
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Fax | 239-829-4709
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | SANTO IGNACIO GARCIA
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Credential | OTR/L
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Telephone | 239-565-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT11998
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License Number State | FL
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