Provider Demographics
NPI:1891991386
Name:DECOMPRESSION AND SPINAL REHAB OF SWFL
Entity Type:Organization
Organization Name:DECOMPRESSION AND SPINAL REHAB OF SWFL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-947-7844
Mailing Address - Street 1:16517 VANDERBILT DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7550
Mailing Address - Country:US
Mailing Address - Phone:239-947-7844
Mailing Address - Fax:239-947-6338
Practice Address - Street 1:16517 VANDERBILT DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7550
Practice Address - Country:US
Practice Address - Phone:239-947-7844
Practice Address - Fax:239-947-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7598111N00000X
FLPT4617225100000X
FL6185490001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6185490001Medicare NSC