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Organization
REHAB SOURCE P A
Active
Organization
REHAB SOURCE P A
Active
Other names
Collier Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDSEL PAGKANLUNGAN (PRESIDENT)
(239) 643-7879
Entity
Organization
Contact information
Practice address
6825 DAVIS BLVD, #157, NAPLES, FL 34104-5331
(239) 643-7879
(239) 643-2951
Mailing address
6825 DAVIS BLVD APT 257, NAPLES, FL 34104-5326
(239) 643-7879
(239) 643-2951
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0007692
FL
225100000X
Physical Therapist
PT0008895
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y018N
BLUECROSS/BLUESHIELD #
FL
01
—
Y036Q
BLUECROSS/BLUESHIELD#
FL
Enumeration date
07/22/2006
Last updated
07/05/2022
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