Provider Demographics
NPI:1063687416
Name:ELITE PHYSICAL THERAPY OF SOUTHWEST FLORIDA INC
Entity Type:Organization
Organization Name:ELITE PHYSICAL THERAPY OF SOUTHWEST FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SENKARIK
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:239-398-7489
Mailing Address - Street 1:2546 NORTHBROOKE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-7960
Mailing Address - Country:US
Mailing Address - Phone:239-653-9586
Mailing Address - Fax:239-653-9587
Practice Address - Street 1:2546 NORTHBROOKE PLAZA
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8100
Practice Address - Country:US
Practice Address - Phone:239-653-9586
Practice Address - Fax:239-653-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21199261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy