Provider Demographics
NPI:1811520901
Name:FLORIDA GULF COAST UNIVERSITY
Entity type:Organization
Organization Name:FLORIDA GULF COAST UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER II
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-590-7462
Mailing Address - Street 1:10501 FGCU BLVD S
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33965-6565
Mailing Address - Country:US
Mailing Address - Phone:239-590-7462
Mailing Address - Fax:
Practice Address - Street 1:10501 FGCU BLVD S
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33965-6565
Practice Address - Country:US
Practice Address - Phone:239-590-7462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA GULF COASTUNIVERSITY WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy