Provider Demographics
NPI:1184677288
Name:GTP MANAGEMENT INC
Entity Type:Organization
Organization Name:GTP MANAGEMENT INC
Other - Org Name:ADIO WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PETRYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC,DACNB,FACFN,FABES
Authorized Official - Phone:239-482-0300
Mailing Address - Street 1:15880 SUMMERLIN RD STE 300
Mailing Address - Street 2:PMB 106
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9613
Mailing Address - Country:US
Mailing Address - Phone:239-482-0300
Mailing Address - Fax:239-482-4757
Practice Address - Street 1:8801 COLLEGE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4882
Practice Address - Country:US
Practice Address - Phone:239-482-0300
Practice Address - Fax:239-482-4757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8431111NN0400X
FLOS7123208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94780OtherBC/BS GROUP PROVIDER #
FL94780OtherBC/BS GROUP PROVIDER #