Healthcare Provider Details

I. General information

NPI: 1700993532
Provider Name (Legal Business Name): RICKY BERNARDO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 CORTEZ RD W POD #2
BRADENTON FL
34210-3104
US

IV. Provider business mailing address

951 BROKEN SOUND PKWY NW
BOCA RATON FL
33487-3507
US

V. Phone/Fax

Practice location:
  • Phone: 941-757-6300
  • Fax: 941-757-8877
Mailing address:
  • Phone: 561-241-9300
  • Fax: 561-372-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT20720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: