Active NPI
Ma. Lourdes Enriquez
- Physical Therapist
- Port Charlotte, FL
National Provider Identifier
1154856763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT30921
- Practice address
- 4166 Tamiami TRL
Suite a
Port Charlotte, FL 33952-9255 - Phone
- (941) 766-1110
- NPI assigned
- Apr 21, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT30921 | FL | Primary |
Addresses
Primary practice location
4166 Tamiami TRL
Suite a
Port Charlotte, FL 33952-9255
Mailing address
4166 Tamiami TRL
Suite a
Port Charlotte, FL 33952-9255
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT30921 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehab 1of Charlotte County, Inc. | Physical Therapist | 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.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Port Charlotte, FL
- NPI 1699866988
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492732800000",
"number": "1154856763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4166 TAMIAMI TRL",
"address_2": "SUITE A",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339529255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4166 TAMIAMI TRL",
"address_2": "SUITE A",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339529255",
"telephone_number": "941-766-1110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENRIQUEZ",
"first_name": "MA. LOURDES",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-21",
"last_updated": "2017-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT30921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Charlotte, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.