Provider Demographics
NPI:1043279458
Name:SOUTHWEST PHYSICAL THERAPY & REHABILITATION INC
Entity Type:Organization
Organization Name:SOUTHWEST PHYSICAL THERAPY & REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULITA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:941-625-1530
Mailing Address - Street 1:4161 TAMIAMI TRL STE 304
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9254
Mailing Address - Country:US
Mailing Address - Phone:941-613-2844
Mailing Address - Fax:941-613-2840
Practice Address - Street 1:4161 TAMIAMI TRL
Practice Address - Street 2:SUITE 304
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-613-2844
Practice Address - Fax:941-613-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy