Provider Demographics
NPI:1174862247
Name:AMBASSADOR REHABILITATIVE SERVICES
Entity Type:Organization
Organization Name:AMBASSADOR REHABILITATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:CAGGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:239-560-0179
Mailing Address - Street 1:991 PONDELLA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-3500
Mailing Address - Country:US
Mailing Address - Phone:239-995-8809
Mailing Address - Fax:
Practice Address - Street 1:991 PONDELLA RD
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3500
Practice Address - Country:US
Practice Address - Phone:239-995-8809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20339225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty