Provider Demographics
NPI:1104889534
Name:SYPERT INSTITUTE PA
Entity type:Organization
Organization Name:SYPERT INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:O GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-432-0774
Mailing Address - Street 1:632 DEL PRADO BLVD N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2253
Mailing Address - Country:US
Mailing Address - Phone:239-772-5577
Mailing Address - Fax:239-772-9961
Practice Address - Street 1:632 DEL PRADO BLVD N
Practice Address - Street 2:SUITE 101
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2278
Practice Address - Country:US
Practice Address - Phone:239-772-5577
Practice Address - Fax:239-772-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3792099-00Medicaid
FL3792099-00Medicaid