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NPI Code Detail

MEDICARE: MIKE KRILL

MEDICARE:   MIKE  KRILL
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1891128344
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKE KRILL
Provider Business Mailing Address
First Line : 2620 SW 46TH ST
Second Line :
City : CAPE CORAL
State : FL
Zip : 33914-6161
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2620 SW 46TH ST
Second Line :
City : CAPE CORAL
State : FL
Zip : 33914-6161
Country : US
Telephone Number : 239-560-1616
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2013
Last Update Date : 08/19/2013

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Directions to “ MIKE KRILL ” Practice Location

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