MEDICARE: DEAN ERIC HAVNER P.T.

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	2251X0800X	Orthopedic Physical Therapist	PT36895	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184772857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN ERIC HAVNER P.T.

Provider Business Mailing Address
First Line	:	6376 PINE RIDGE RD UNIT 430
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-3928
Country	:	US
Telephone Number	:	239-316-7600
Fax Number	:	239-316-7509

Provider Business Practice Location Address
First Line	:	6376 PINE RIDGE RD UNIT 430
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-3928
Country	:	US
Telephone Number	:	239-316-7600
Fax Number	:	239-316-7509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	05/25/2023

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