Provider Demographics
NPI:1831350362
Name:PEDS ORTHO PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PEDS ORTHO PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-432-5100
Mailing Address - Street 1:15880 SUMMERLIN RD
Mailing Address - Street 2:STE 300 PMB 322
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9612
Mailing Address - Country:US
Mailing Address - Phone:239-432-5100
Mailing Address - Fax:239-432-5135
Practice Address - Street 1:15821 HOLLYFERN CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3732
Practice Address - Country:US
Practice Address - Phone:239-432-5100
Practice Address - Fax:239-432-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy