Provider Demographics
NPI:1720747603
Name:IANNI, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:IANNI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6376 PINE RIDGE RD STE 430
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3905
Mailing Address - Country:US
Mailing Address - Phone:239-316-7600
Mailing Address - Fax:239-316-7509
Practice Address - Street 1:6376 PINE RIDGE RD STE 430
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3905
Practice Address - Country:US
Practice Address - Phone:239-316-7600
Practice Address - Fax:239-316-7509
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT307052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT30705OtherFLORIDA LICENSE