Provider Demographics
NPI:1154762276
Name:INJURY TREATMENT CENTER OF FORT MYERS, INC.
Entity type:Organization
Organization Name:INJURY TREATMENT CENTER OF FORT MYERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SVABEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-489-2290
Mailing Address - Street 1:2295 NW CORPORATE BLVD
Mailing Address - Street 2:#245
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7373
Mailing Address - Country:US
Mailing Address - Phone:561-988-0545
Mailing Address - Fax:
Practice Address - Street 1:8595 COLLEGE PKWY
Practice Address - Street 2:#110
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5191
Practice Address - Country:US
Practice Address - Phone:239-489-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10331332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site