Provider Demographics
NPI:1841250826
Name:FRATTARELLI, EDWARD (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:FRATTARELLI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 TAMIAMI TR
Mailing Address - Street 2:STE 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948
Mailing Address - Country:US
Mailing Address - Phone:941-629-6262
Mailing Address - Fax:941-629-1782
Practice Address - Street 1:1641 TAMIAMI TR
Practice Address - Street 2:STE 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948
Practice Address - Country:US
Practice Address - Phone:941-629-6262
Practice Address - Fax:941-629-1782
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT18643OtherPT
FLU5351ZMedicare PIN
FL0873960001Medicare NSC