MEDICARE: SOUTHWEST PHYSICAL THERAPY & REHABILITATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1043279458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST PHYSICAL THERAPY & REHABILITATION INC

Provider Business Mailing Address
First Line	:	4161 TAMIAMI TRL STE 304
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-9254
Country	:	US
Telephone Number	:	941-613-2844
Fax Number	:	941-613-2840

Provider Business Practice Location Address
First Line	:	4161 TAMIAMI TRL
Second Line	:	SUITE 304
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-9204
Country	:	US
Telephone Number	:	941-613-2844
Fax Number	:	941-613-2840

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. JULITA E. LATHERS
Credential	:	R.N.
Telephone Number	:	941-625-1530

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/15/2009

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