Provider Demographics
NPI:1891093068
Name:BONETT REHAB CENTER INC
Entity Type:Organization
Organization Name:BONETT REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRAZANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-481-2200
Mailing Address - Street 1:3900 BROADWAY BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8193
Mailing Address - Country:US
Mailing Address - Phone:239-481-2200
Mailing Address - Fax:239-481-2209
Practice Address - Street 1:3900 BROADWAY BLDG B UNIT-7
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8193
Practice Address - Country:US
Practice Address - Phone:239-481-2200
Practice Address - Fax:239-481-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy