Basic Information
| Provider Information | |||||||||
| NPI: | 1770823304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONCOLOGY AND ORTHOPEDIC PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8805 TAMIAMI TRL N | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341082525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392781155 | ||||||||
| FaxNumber: | 2392781159 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 TRAIL BLVD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341082856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392781155 | ||||||||
| FaxNumber: | 2392781159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2013 | ||||||||
| LastUpdateDate: | 02/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | RUETH | ||||||||
| AuthorizedOfficialFirstName: | MARY KAYE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2392781155 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | PT23764 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | PT23764 | 01 | FL | LICENSE | OTHER |