Provider Demographics
NPI:1699960435
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:OGRADY
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:
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 1:26800 TAMIAMI TRAIL SOUTH
Practice Address - Street 2:SUITE 340
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4349
Practice Address - Country:US
Practice Address - Phone:239-498-1204
Practice Address - Fax:239-498-1350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYPERT INSTITUTE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-13
Last Update Date:2011-09-28
Deactivation Date:2009-05-19
Deactivation Code:
Reactivation Date:2011-09-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379209900Medicaid
FL33983BMedicare PIN
FL379209900Medicaid