MEDICARE: DR. MICHELE L DAVE PT, DPT

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	225100000X	Physical Therapist	PT35667	FL
2	225100000X	Physical Therapist	4OQAO1131300	NJ

General Provider Information

NPI Number	:	1275663411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE L DAVE PT, DPT

Provider Business Mailing Address
First Line	:	2619 FORUM BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5605
Country	:	US
Telephone Number	:	239-676-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 ASTON GARDENS WAY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-3501
Country	:	US
Telephone Number	:	239-676-2080
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	03/22/2021

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