Healthcare Provider Details

I. General information

NPI: 1952755852
Provider Name (Legal Business Name): DAVID OSMOND PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2016
Last Update Date: 04/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 PINEBROOK RD
VENICE FL
34285-6421
US

IV. Provider business mailing address

337 GLEN OAK RD
VENICE FL
34293-1104
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-6733
  • Fax:
Mailing address:
  • Phone: 941-525-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPTA 26398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: