1467977264 NPI number — DR. JAMES RUSSELL BARD DPT

Table of content: DR. DAVID F PORTER D.O. (NPI 1588673180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467977264 NPI number — DR. JAMES RUSSELL BARD DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARD
Provider First Name:
JAMES
Provider Middle Name:
RUSSELL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467977264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3434 SKYSAIL PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33607-5828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-283-9269
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 W CLEVELAND ST STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33606-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-581-3805
Provider Business Practice Location Address Fax Number:
844-757-3728
Provider Enumeration Date:
08/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT32796 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT32796 . This is a "FLORIDA STATE PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com