Provider Demographics
NPI:1538310693
Name:SANTORE, TODD MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:SANTORE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1459
Mailing Address - Country:US
Mailing Address - Phone:239-573-1518
Mailing Address - Fax:239-573-7356
Practice Address - Street 1:13670 METROPOLIS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4346
Practice Address - Country:US
Practice Address - Phone:239-561-0700
Practice Address - Fax:239-561-0103
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68-6520OtherMEDICARE GROUP