Provider Demographics
NPI:1477062776
Name:SOUTH VENICE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SOUTH VENICE PHYSICAL THERAPY
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:I
Authorized Official - Last Name:TRIBIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-375-8734
Mailing Address - Street 1:109 LAUREL RD E
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-5233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-1819
Practice Address - Country:US
Practice Address - Phone:941-375-8734
Practice Address - Fax:941-375-8734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty