Provider Demographics
NPI:1770823304
Name:ONCOLOGY AND ORTHOPEDIC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ONCOLOGY AND ORTHOPEDIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY KAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUETH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:239-278-1155
Mailing Address - Street 1:8805 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 211
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2525
Mailing Address - Country:US
Mailing Address - Phone:239-278-1155
Mailing Address - Fax:239-278-1159
Practice Address - Street 1:7700 TRAIL BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2856
Practice Address - Country:US
Practice Address - Phone:239-278-1155
Practice Address - Fax:239-278-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23764208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT23764OtherLICENSE