Provider Demographics
NPI:1528015047
Name:PHYSIOWORKS INC
Entity Type:Organization
Organization Name:PHYSIOWORKS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, PT
Authorized Official - Phone:941-497-1737
Mailing Address - Street 1:836 SUNSET LAKE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-7554
Mailing Address - Country:US
Mailing Address - Phone:941-497-1737
Mailing Address - Fax:941-497-7889
Practice Address - Street 1:836 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7554
Practice Address - Country:US
Practice Address - Phone:941-497-1737
Practice Address - Fax:941-497-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR6DOtherBCBS FL PROVIDER #
FL106890Medicare ID - Type UnspecifiedCERTIFIED REHAB AGENCY