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General NPI Number Information
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NPI Number | 1750855037
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Entity Type | Individual
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Provider Name | ROBERT MAND PTA
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Gender | Male
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Dates
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Enumeration Date | 01/19/2019
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Last Update Date | 01/19/2019
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Provider Practice Location Address
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Address Line | 490 S OLD WIRE RD
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City | WILDWOOD
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State | FL
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Zip | 34785-5001
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Country | US
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Telephone | 352-748-3683
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Fax |
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Provider Business Mailing Address
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Address Line | 9118 E MOCCASIN SLOUGH RD
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City | INVERNESS
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State | FL
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Zip | 34450-6203
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Country | US
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Telephone | 352-860-2417
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 20147
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License Number State | FL
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