MEDICARE: DR. JAMES RUSSELL BARD DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT32796	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT32796	OTHER	FL	FLORIDA STATE PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1467977264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES RUSSELL BARD DPT

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

Provider Business Practice Location Address
First Line	:	1501 W CLEVELAND ST STE 220
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1812
Country	:	US
Telephone Number	:	810-581-3805
Fax Number	:	844-757-3728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	03/12/2023

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