Healthcare Provider Details

I. General information

NPI: 1114557865
Provider Name (Legal Business Name): JEFFREY EIMER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 59TH ST W
BRADENTON FL
34209-4602
US

IV. Provider business mailing address

3604 31ST ST E
BRADENTON FL
34208-7251
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-1000
  • Fax:
Mailing address:
  • Phone: 941-718-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT33573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: