Provider Demographics
NPI:1104940899
Name:ALLIED PHYSICAL THERAPY, P.A.
Entity type:Organization
Organization Name:ALLIED PHYSICAL THERAPY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARKNESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:239-242-0070
Mailing Address - Street 1:ALLIED PHYSICAL THERAPY, P.A.
Mailing Address - Street 2:1469 SW 4TH TERRACE
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1424
Mailing Address - Country:US
Mailing Address - Phone:239-242-0070
Mailing Address - Fax:239-242-0076
Practice Address - Street 1:ALLIED PHYSICAL THERAPY, P.A.
Practice Address - Street 2:1469 SW 4TH TERRACE
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1424
Practice Address - Country:US
Practice Address - Phone:239-242-0070
Practice Address - Fax:239-242-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0700056666261QP2000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY917VOtherBLUE CROSS BLUE SHIELD
FLK6261Medicare ID - Type UnspecifiedMEDICARE NUMBER