Healthcare Provider Details

I. General information

NPI: 1477787711
Provider Name (Legal Business Name): AUBREY H BAHR LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 MADACA LN
TAMPA FL
33618-2048
US

IV. Provider business mailing address

3605 MADACA LN
TAMPA FL
33618-2048
US

V. Phone/Fax

Practice location:
  • Phone: 813-385-4820
  • Fax: 813-455-3155
Mailing address:
  • Phone: 813-385-4820
  • Fax: 813-455-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberMA 53329
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: