MEDICARE: RAWLINS BRIDGEWATER PT, 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	9984	CT
2	225100000X	Physical Therapist	PTH6925	AL
3	225100000X	Physical Therapist	PT29085	FL
4	225100000X	Physical Therapist	1241363	TX

General Provider Information

NPI Number	:	1881025716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAWLINS BRIDGEWATER PT, DPT

Provider Business Mailing Address
First Line	:	955 AIRPORT RD
Second Line	:	APT 1123
City	:	DESTIN
State	:	FL
Zip	:	32541-2815
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2530 BOBCAT VILLAGE CENTER RD UNIT C
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8475
Country	:	US
Telephone Number	:	941-426-7400
Fax Number	:

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

Provider Enumeration Date	:	12/03/2013
Last Update Date	:	04/03/2014

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