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General NPI Number Information
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NPI Number | 1992789549
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Entity Type | Organization
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Legal Business Name | MANATEE GLENS
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 379 6TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-8820
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Country | US
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Telephone | 941-782-4299
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Fax |
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Provider Business Mailing Address
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Address Line | 379 6TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-8820
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OUTPATIENT THERAPIST
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Name | BARBARA WHITE CLAVEY
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Credential |
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Telephone | 941-782-4299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | MH5954
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License Number State | FL
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