Organization
AMERICAN HOME THERAPY PROVIDER INC.
Active
Other names
charlotte physical therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GRACE L. PENANO RPT (COO/ ADMINISTRATOR)
(941) 766-1235
Entity
Organization
Contact information
Practice address
3380 TAMIAMI TRL STE C, PORT CHARLOTTE, FL 33952-8156
(941) 766-1235
(941) 766-1644
Mailing address
3380 TAMIAMI TRL STE C, PORT CHARLOTTE, FL 33952-8156
(941) 766-1235
(941) 766-1644
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
686552
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT7217
LICENSE PHYSICAL THERAPY
FL
01
—
PT7840
FL PHYSICAL THERAPY LICEN
FL
01
—
Q5D
BCBS FL
FL
Enumeration date
11/01/2006
Last updated
05/30/2012
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