Provider Demographics
NPI:1700823358
Name:TROTTIER, NEAL RYAN (PT)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:RYAN
Last Name:TROTTIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5658 EICHEN CIR
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-2520
Mailing Address - Country:US
Mailing Address - Phone:239-415-2770
Mailing Address - Fax:239-945-5441
Practice Address - Street 1:700 EL DORADO PKWY W
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-7232
Practice Address - Country:US
Practice Address - Phone:239-945-5440
Practice Address - Fax:239-945-5441
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare ID - Type Unspecified