Provider Demographics
NPI:1174818801
Name:POIRIER, JEFFREY GENE (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GENE
Last Name:POIRIER
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 1:4790 S CLEVELAND AVE
Mailing Address - Street 2:APT 2005
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1300
Mailing Address - Country:US
Mailing Address - Phone:239-772-2363
Mailing Address - Fax:
Practice Address - Street 1:1425 VISCAYA PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3294
Practice Address - Country:US
Practice Address - Phone:239-772-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT25684OtherFLORIDA PT LICENSE NUMBER