Organization
BOLLETTIERI SPORTS MEDICINE CENTER
Active
Organization
BOLLETTIERI SPORTS MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY S FRYE PT (MANAGING PARTNER)
(941) 755-0068
Entity
Organization
Contact information
Practice address
5500 34TH STREET WEST, BRADENTON, FL 34210-3506
(941) 755-0068
(941) 727-7502
Mailing address
5500 34TH STREET WEST, BRADENTON, FL 34210-3506
(941) 755-0068
(941) 727-7502
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5864226-003
CIGNA HEALTHCARE
FL
01
—
Q3B
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
11/15/2006
Last updated
02/16/2012
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