Provider Demographics
NPI:1093044349
Name:PAREDES, DWIGHT JAMES PINO (RPT)
Entity Type:Individual
Prefix:
First Name:DWIGHT JAMES
Middle Name:PINO
Last Name:PAREDES
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 MATTHEW DR
Mailing Address - Street 2:APT 5
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1711
Mailing Address - Country:US
Mailing Address - Phone:862-226-2935
Mailing Address - Fax:
Practice Address - Street 1:7460 LAKE BREEZE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8090
Practice Address - Country:US
Practice Address - Phone:239-481-6615
Practice Address - Fax:239-481-6654
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist