Provider Demographics
NPI:1093822397
Name:BATTILANA, JORGE LUIS (PT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:BATTILANA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 TAMIAMI TRL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3027
Mailing Address - Country:US
Mailing Address - Phone:239-643-2040
Mailing Address - Fax:239-643-2080
Practice Address - Street 1:4949 TAMIAMI TRL
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3027
Practice Address - Country:US
Practice Address - Phone:239-643-2040
Practice Address - Fax:239-643-2080
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y032MMedicare ID - Type UnspecifiedMEDICARE