Provider Demographics
NPI:1205980224
Name:RIBBEL, BRUCE KEVIN (PT-CLT)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:KEVIN
Last Name:RIBBEL
Suffix:
Gender:M
Credentials:PT-CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GOODLETTE RD N STE B104
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5664
Mailing Address - Country:US
Mailing Address - Phone:239-263-1922
Mailing Address - Fax:239-263-2710
Practice Address - Street 1:501 GOODLETTE RD N STE B104
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5664
Practice Address - Country:US
Practice Address - Phone:239-263-1922
Practice Address - Fax:239-263-2710
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1851Medicare ID - Type Unspecified