Provider Demographics
NPI:1952492993
Name:ABSOLUTE PHYSICAL THERAPY OF SOUTHWEST FLORIDA LLC
Entity Type:Organization
Organization Name:ABSOLUTE PHYSICAL THERAPY OF SOUTHWEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYNELL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:239-494-4241
Mailing Address - Street 1:9401 FOUNTAIN MEDICAL CT
Mailing Address - Street 2:UNIT D101
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4612
Mailing Address - Country:US
Mailing Address - Phone:239-494-4241
Mailing Address - Fax:239-390-2678
Practice Address - Street 1:9401 FOUNTAIN MEDICAL CT
Practice Address - Street 2:UNIT D101
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4612
Practice Address - Country:US
Practice Address - Phone:239-494-4241
Practice Address - Fax:239-390-2678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 5033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG364Medicare PIN