=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790021731
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OREN ROSENTHAL P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2012
-----------------------------------------------------
Last Update Date | 12/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7628 DOUBLE PINE DR
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34240-1430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-343-0188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7628 DOUBLE PINE DR
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34240-1430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-343-0188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT16908
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------