Provider Demographics
NPI:1396494035
Name:SOUTHWEST FLORIDA PELVIC HEALTH CLINIC
Entity type:Organization
Organization Name:SOUTHWEST FLORIDA PELVIC HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:NASSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-248-6056
Mailing Address - Street 1:3200 BAILEY LN STE 111
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-8506
Mailing Address - Country:US
Mailing Address - Phone:239-248-6056
Mailing Address - Fax:
Practice Address - Street 1:3200 BAILEY LN STE 111
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-8506
Practice Address - Country:US
Practice Address - Phone:239-248-6056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty