Organization
65 PLUS LLC
Active
Other names
65 Plus Physical Therapy - Country Club Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW CORN DPT (PRESIDENT)
(941) 451-6691
Entity
Organization
Contact information
Practice address
1978 TAMIAMI TRL S, SUITE 5 & 6, VENICE, FL 34293-5006
(941) 451-6607
(941) 451-2028
Mailing address
350 W VENICE AVE # 1946, VENICE, FL 34285-0001
(941) 451-6691
(941) 451-2028
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
21464
FL
Other
Enumeration date
01/04/2016
Last updated
06/14/2016
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