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NPI Code Detail

MEDICARE: MR. BRUCE F NATHAN PT

MEDICARE: MR. BRUCE F NATHAN PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT18512FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164603486
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE F NATHAN PT
Provider Business Mailing Address
First Line : 3562 SW COCO PALM DR
Second Line :
City : PALM CITY
State : FL
Zip : 34990-3158
Country : US
Telephone Number : 772-208-0101
Fax Number :
Provider Business Practice Location Address
First Line : 9401 SW DISCOVERY WAY STE 202
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34987-2381
Country : US
Telephone Number : 772-288-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2007
Last Update Date : 09/15/2022

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