Organization
COUNTRY CLUB PT PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA CORN (OFFICE MANAGER)
(941) 451-6689
Entity
Organization
Contact information
Practice address
1331 WHISPERING LN, VENICE, FL 34285-6449
(941) 451-6689
Mailing address
1331 WHISPERING LN, VENICE, FL 34285-6449
(941) 451-6689
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PT21464
FL
Other
Enumeration date
12/19/2015
Last updated
12/19/2015
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