Provider Demographics
NPI:1992919500
Name:PIGNATARO, ROSE MARIE (PT, DPT, PHD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:MARIE
Last Name:PIGNATARO
Suffix:
Gender:F
Credentials:PT, DPT, PHD
Other - Prefix:DR
Other - First Name:ROSE
Other - Middle Name:MARIE
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, PHD
Mailing Address - Street 1:10501 FGCU BLVD S
Mailing Address - Street 2:DEPARTMENT OF REHABILITATION SCIENCES
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33965-6565
Mailing Address - Country:US
Mailing Address - Phone:631-827-3008
Mailing Address - Fax:
Practice Address - Street 1:12734 KENWOOD LN
Practice Address - Street 2:SUITE 56
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5666
Practice Address - Country:US
Practice Address - Phone:239-936-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ23891Medicare UPIN