Provider Demographics
NPI:1114644762
Name:ISLANDFIT PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:ISLANDFIT PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:BRONSORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-314-5118
Mailing Address - Street 1:11400 SUMMERLIN SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-5300
Mailing Address - Country:US
Mailing Address - Phone:239-314-5118
Mailing Address - Fax:239-314-5119
Practice Address - Street 1:11400 SUMMERLIN SQUARE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931-5300
Practice Address - Country:US
Practice Address - Phone:239-314-5118
Practice Address - Fax:239-314-5119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies