Provider Demographics
NPI:1619926292
Name:PARAGON PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PARAGON PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNABELLE
Authorized Official - Middle Name:BERTULFO
Authorized Official - Last Name:VITUG
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:9413-231-3397
Mailing Address - Street 1:6015 44TH CT E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-7022
Mailing Address - Country:US
Mailing Address - Phone:941-321-3397
Mailing Address - Fax:941-739-6028
Practice Address - Street 1:3920 BEE RIDGE RD
Practice Address - Street 2:BUILDING E, SUITE H
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1207
Practice Address - Country:US
Practice Address - Phone:941-924-4605
Practice Address - Fax:941-924-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0009493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1982816435OtherNPI
FL1619926292OtherNPI
FL1780896712OtherNPI
FLU3996YMedicare PIN
FL1780896712OtherNPI
FLU5481AMedicare PIN