Functional Rehab of East Ft. Myers, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 7037 Issued in FL

Legal business name

FUNCTIONAL REHAB OF EAST FT. MYERS, INC.

Practice address

14630 Palm Beach Blvd
Suite 6
Fort Myers, FL 33905-2333

Phone

(239) 690-3100

Fax

(239) 693-3200

NPI assigned

May 16, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Diego Diaz Sausa Jr., MA, D.P.T.NPI 1174567481

Title

President

Phone

(239) 850-1891

Specialties & licenses 1

Addresses

Other names 1

• Rehab & Pain Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 6

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

• Diego Diaz Sausa Jr., M.A., DPT

  • Physical Therapist
  • Fort Myers, FL
  • NPI 1174567481
  Medicare reassignment NPD Authorized official
• Jeanne Marie Blake

  • Physical Therapy Assistant
  • Naples, FL
  • NPI 1174012553
  NPD
• John Var Andoy Estorco, PT

  • Physical Therapist
  • Fort Myers, FL
  • NPI 1023358587
  NPD (past)
• Anne Marie Fitzgibbons, CCC-SLP

  • Speech-Language Pathologist
  • Fort Myers, FL
  • NPI 1528269222
  NPD (past)
• Michael Edwin Tufaro, O.T.R.

  • Hand Occupational Therapist
  • Fort Myers, FL
  • NPI 1659349157
  NPD (past)
• Conseulo Villareal, RPT

  • Physical Therapist
  • Ellenton, FL
  • NPI 1952502874
  NPD (past)

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406073600000",
    "number": "1699727156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2565",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022565",
            "telephone_number": "239-690-3100",
            "fax_number": "239-693-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14630 PALM BEACH BLVD",
            "address_2": "SUITE 6",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339052333",
            "telephone_number": "239-690-3100",
            "fax_number": "239-693-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL REHAB OF EAST FT. MYERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2014-07-23",
        "status": "A",
        "authorized_official_last_name": "SAUSA",
        "authorized_official_first_name": "DIEGO",
        "authorized_official_middle_name": "DIAZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-850-1891",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MA, D.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 7037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rehab & Pain Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chelsea Cree Fullgrapp, DDS
• Ellen-Beth Fullwood, MS CCC-SLP
• Fulton Chiropractic P a
• Charles L Fulton, D.C.
• Alexandra Fumero
• Breana Nicole Fundermark
• Robert William Fung, DO
• Oronzo Furio, M.D.
• Julie Furlong, RPTA-WCC
• Lesley Phyllis Furman, MD

• Physical Therapist in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; 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.