Healthcare Provider Details

I. General information

NPI: 1225777188
Provider Name (Legal Business Name): MICHAEL HARDIGREE BT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10817 BLOOMINGDALE AVE
RIVERVIEW FL
33578-3616
US

IV. Provider business mailing address

3433 EAGLE RIDGE CT
VALRICO FL
33596-6159
US

V. Phone/Fax

Practice location:
  • Phone: 866-311-4617
  • Fax:
Mailing address:
  • Phone: 813-993-5942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: