Provider Demographics
NPI:1518011436
Name:HOLISTIC PHYSICAL THERAPY AND LYMPHEDEMA SERVICES INC.
Entity Type:Organization
Organization Name:HOLISTIC PHYSICAL THERAPY AND LYMPHEDEMA SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIBBEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:239-263-1922
Mailing Address - Street 1:501 GOODLETTE RD N STE B104
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5664
Mailing Address - Country:US
Mailing Address - Phone:239-263-1922
Mailing Address - Fax:
Practice Address - Street 1:501 GOODLETTE RD N STE B104
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5664
Practice Address - Country:US
Practice Address - Phone:239-263-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1851Medicare ID - Type UnspecifiedMEDICARE ID