Provider Demographics
NPI:1306359617
Name:PRECISION PHYSICAL MEDICINE, LLC
Entity Type:Organization
Organization Name:PRECISION PHYSICAL MEDICINE, LLC
Other - Org Name:COMPLETE PHYSICAL MEDICINE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-908-0899
Mailing Address - Street 1:PO BOX 151850
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915-1850
Mailing Address - Country:US
Mailing Address - Phone:239-908-0899
Mailing Address - Fax:239-791-5526
Practice Address - Street 1:6811 PORTO FINO CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4354
Practice Address - Country:US
Practice Address - Phone:239-288-2218
Practice Address - Fax:239-791-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
FLCH11936261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty