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General NPI Number Information
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NPI Number | 1417085069
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Entity Type | Individual
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Provider Name | MR. PIETER H. TEPASKE
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 2530 BOBCAT VILLAGE CENTER RD UNIT C
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City | NORTH PORT
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State | FL
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Zip | 34288
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Country | US
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Telephone | 941-426-7400
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Fax | 941-426-7044
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Provider Business Mailing Address
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Address Line | 3657 CORTEZ RD W STE 110
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City | BRADENTON
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State | FL
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Zip | 34210-3171
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Country | US
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Telephone | 941-544-5060
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Fax | 941-426-7044
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0007476
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License Number State | FL
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