Peace River Physical Therapy & Rehabilitation, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PEACE RIVER PHYSICAL THERAPY & REHABILITATION, LLC

Practice address

2200 Kings Hwy Unit 2F
Port Charlotte, FL 33980-5760

Phone

(941) 888-4561

Fax

(941) 347-4695

NPI assigned

Nov 27, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lance D Doeble, MSPTNPI 1821248170

Title

Ambr

Phone

(941) 888-4561

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lance D Doeble, MSPT

  • Physical Therapist
  • Port Charlotte, FL
  • NPI 1821248170
  Medicare reassignment NPD Authorized official
• Judith Ann Cusimano-Connors, OT

  • Occupational Therapist
  • Port Charlotte, FL
  • NPI 1265141105
  NPD
• Mary C Vega, PT

  • Physical Therapist
  • Port Charlotte, FL
  • NPI 1144857699
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1285104828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 510326",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339510326",
            "telephone_number": "941-888-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 KINGS HWY UNIT 2F",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339805760",
            "telephone_number": "941-888-4561",
            "fax_number": "941-347-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACE RIVER PHYSICAL THERAPY & REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-27",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "DOEBLE",
        "authorized_official_first_name": "LANCE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "AMBR",
        "authorized_official_telephone_number": "941-888-4561",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• PCP - Health PLLC
• Peace of Mind Internal Medicine PLLC Jennifer a Cooke Sole MBR
• Peace River Ankle & Foot, PL
• Peace River Cardiovascular Center
• Peace River Hma Nursing Center Inc (Peace River Nursing and Rehabilitation)
• Peace River Surgery Center
• Peachland Chiropractic Health LLC
• Olena Pease, CRNA
• Eric Pecoraro
• Pediatric Dentistry of Port Charlotte

• Physical Therapy Clinic/Center in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.