MEDICARE: RICHARD ALLAN NAIDER PTA

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	225200000X	Physical Therapy Assistant	PTA1550	FL

General Provider Information

NPI Number	:	1629229471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ALLAN NAIDER PTA

Provider Business Mailing Address
First Line	:	2155 ELM ST
Second Line	:	UNIT 701
City	:	DUNEDIN
State	:	FL
Zip	:	34698-5666
Country	:	US
Telephone Number	:	727-734-5054
Fax Number	:

Provider Business Practice Location Address
First Line	:	6613 49TH ST
Second Line	:	NORTH
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-5728
Country	:	US
Telephone Number	:	727-527-2100
Fax Number	:	727-521-3710

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

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	10/09/2008

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