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General NPI Number Information
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NPI Number | 1699847988
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Entity Type | Individual
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Provider Name | BRANDIE S TATRO MSPT
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5500 34TH ST W
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City | BRADENTON
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State | FL
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Zip | 34210-3506
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Country | US
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Telephone | 941-755-0068
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Fax | 941-727-7502
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Provider Business Mailing Address
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Address Line | 6805 11TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-4060
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Country | US
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Telephone | 859-983-1514
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Fax |
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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 | PT 22202
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT004137
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License Number State | KY
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