Provider Demographics
NPI:1700940020
Name:PHYSIOWORKS INC
Entity Type:Organization
Organization Name:PHYSIOWORKS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, PT
Authorized Official - Phone:941-497-1737
Mailing Address - Street 1:1279 N SUMTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-8021
Mailing Address - Country:US
Mailing Address - Phone:941-240-8602
Mailing Address - Fax:941-240-8607
Practice Address - Street 1:1279 N SUMTER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-8021
Practice Address - Country:US
Practice Address - Phone:941-240-8602
Practice Address - Fax:941-240-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4313225100000X
FLOT3289225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106890Medicare Oscar/Certification