Healthcare Provider Details

I. General information

NPI: 1487933727
Provider Name (Legal Business Name): DANIEL OBRADOVICH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 N HARBOR CITY BLVD
MELBOURNE FL
32935-6203
US

IV. Provider business mailing address

3260 N HARBOR CITY BLVD
MELBOURNE FL
32935-6203
US

V. Phone/Fax

Practice location:
  • Phone: 321-693-8196
  • Fax: 321-373-4007
Mailing address:
  • Phone: 321-693-8196
  • Fax: 321-373-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: