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General NPI Number Information
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NPI Number | 1992890693
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Entity Type | Organization
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Legal Business Name | FLORIDA GULFCOAST PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 10011 ESTERO TOWN COMMONS PL SUITE 101A
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City | ESTERO
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State | FL
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Zip | 33928
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Country | US
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Telephone | 239-948-2222
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Fax | 239-948-2225
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Provider Business Mailing Address
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Address Line | 10011 ESTERO TOWN COMMONS PL SUITE 101A
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City | ESTERO
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State | FL
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Zip | 33928-9465
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Country | US
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Telephone | 239-948-2222
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Fax | 239-948-2225
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Authorized Official
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Title or Position | COOPERATING MANAGER
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Name | MR. GLEN FRANKLIN METRICK
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Credential | PHYSICAL THERAPIST
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Telephone | 239-948-2222
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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 | 0603462
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License Number State | FL
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