Provider Demographics
NPI:1275028375
Name:PRESUTTI, EVER L (PTA)
Entity Type:Individual
Prefix:
First Name:EVER
Middle Name:L
Last Name:PRESUTTI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18359 GYPSY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-1846
Mailing Address - Country:US
Mailing Address - Phone:941-661-2471
Mailing Address - Fax:
Practice Address - Street 1:12749 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1934
Practice Address - Country:US
Practice Address - Phone:941-426-3934
Practice Address - Fax:941-426-5487
Is Sole Proprietor?:No
Enumeration Date:2018-06-30
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28208225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant