Healthcare Provider Details

I. General information

NPI: 1063471340
Provider Name (Legal Business Name): ANGELA BEDNAREK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 WILD MYRTLE CT
WINDERMERE FL
34786-7844
US

IV. Provider business mailing address

3419 WILD MYRTLE CT
WINDERMERE FL
34786-7844
US

V. Phone/Fax

Practice location:
  • Phone: 407-612-6050
  • Fax:
Mailing address:
  • Phone: 407-612-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22029
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4297
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: