Active NPI
Trina Jane Puddefoot, DSC. PT
- Physical Therapist
- Fort Myers, FL
National Provider Identifier
1104919935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 21360
- Practice address
- 12220 Towne Lake Dr Ste 1
Fort Myers, FL 33913-8021 - Phone
- (239) 433-6700
- Fax
- (239) 433-6703
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | |||
| Physical Therapist | 225100000X | PT 21360 | FL | Primary |
Addresses
Primary practice location
12220 Towne Lake Dr Ste 1
Fort Myers, FL 33913-8021
Mailing address
12220 Towne Lake Dr Ste 1
Fort Myers, FL 33913-8021
Phone (239) 910-5199
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000805900 | Medicaid | FL | |
| 889568600 | Medicaid | FL | |
| 811530300 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 21360 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Rehab Services, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rehabilitation Practitioner
- Fort Myers, FL
- NPI 1700843414
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758758400000",
"number": "1104919935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12220 TOWNE LAKE DR STE 1",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339138021",
"telephone_number": "239-910-5199",
"fax_number": "239-433-6703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12220 TOWNE LAKE DR STE 1",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339138021",
"telephone_number": "239-433-6700",
"fax_number": "239-433-6703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUDDEFOOT",
"first_name": "TRINA",
"middle_name": "JANE",
"name_prefix": "Dr.",
"credential": "DSC. PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2025-09-25",
"certification_date": "2025-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT 21360",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000805900",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "889568600",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "811530300",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.