Healthcare Provider Details

I. General information

NPI: 1093660151
Provider Name (Legal Business Name): JOHN GREGORY POWELL RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12920 SUMMERFIELD CROSSING BLVD
RIVERVIEW FL
33579-7210
US

IV. Provider business mailing address

423 158TH ST E
BRADENTON FL
34212-8175
US

V. Phone/Fax

Practice location:
  • Phone: 813-998-8600
  • Fax:
Mailing address:
  • Phone: 813-998-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT22588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: