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NPI Code Detail

MEDICARE: PRECISION PHYSICAL MEDICINE, LLC

MEDICARE: PRECISION PHYSICAL MEDICINE, LLC
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
1207R00000XInternal Medicine Physician
2261QR0400XRehabilitation Clinic/CenterCH11936FL

General Provider Information

NPI Number : 1306359617
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRECISION PHYSICAL MEDICINE, LLC
Provider Business Mailing Address
First Line : PO BOX 151850
Second Line :
City : CAPE CORAL
State : FL
Zip : 33915-1850
Country : US
Telephone Number : 239-908-0899
Fax Number : 239-791-5526
Provider Business Practice Location Address
First Line : 6811 PORTO FINO CIR
Second Line :
City : FORT MYERS
State : FL
Zip : 33912-4354
Country : US
Telephone Number : 239-288-2218
Fax Number : 239-791-5526
Authorized Official
Title or Position : OWNER
Name : DR. JAMES BOLGER
Credential : DC
Telephone Number : 239-908-0899
Provider Enumeration Date : 11/08/2017
Last Update Date : 12/13/2017

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Directions to “PRECISION PHYSICAL MEDICINE, LLC ” Practice Location

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