Provider Demographics
NPI:1447816657
Name:SKYWAY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SKYWAY PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBONELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:912-856-8118
Mailing Address - Street 1:105 POMPANO DR SE APT D
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-4076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7750 PLANTATION CIR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34201-2064
Practice Address - Country:US
Practice Address - Phone:912-856-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy