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Organization
SOUTHWEST ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Active
Organization
SOUTHWEST ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Active
Other names
S O S Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA MARTIN PT (VICE PRESIDENT)
(941) 255-5940
Entity
Organization
Contact information
Practice address
315 E OLYMPIA AVE, SUITE 212, PUNTA GORDA, FL 33950-3833
(941) 255-5940
(941) 255-5943
Mailing address
315 E OLYMPIA AVE, SUITE 212, PUNTA GORDA, FL 33950-3833
(941) 255-5940
(941) 255-5943
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT2914
FL
225100000X
Physical Therapist
Primary
PT3524
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
QK8
BLUE CROSS BLUE SHIELD
FL
01
—
R6V
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/10/2006
Last updated
10/15/2009
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