=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174138028
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NECATI BRIAN EKREN PTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2020
-----------------------------------------------------
Last Update Date | 09/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2349 SUNSET POINT RD STE 400
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33765-1439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-723-8457
-----------------------------------------------------
Fax | 727-723-8467
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2349 SUNSET POINT RD STE 400
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33765-1439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-723-8457
-----------------------------------------------------
Fax | 727-723-8467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 24668
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------