Basic Information
| Provider Information | |||||||||
| NPI: | 1033433081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TCHETVERGOVA | ||||||||
| FirstName: | DARIA | ||||||||
| MiddleName: | VALERIEVNA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18070 S TAMIAMI TRL | ||||||||
| Address2: | STE 15 | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339084602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393444448 | ||||||||
| FaxNumber: | 2393444449 | ||||||||
| Practice Location | |||||||||
| Address1: | 15620 MCGREGOR BLVD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339082528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394546262 | ||||||||
| FaxNumber: | 2394540350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2010 | ||||||||
| LastUpdateDate: | 02/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT25405 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.