MEDICARE: NATHAN MCBRAYER

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
1	225100000X	Physical Therapist	PTT40351	FL

General Provider Information

NPI Number	:	1194402511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN MCBRAYER

Provider Business Mailing Address
First Line	:	3010 E 138TH AVE STE 1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-3902
Country	:	US
Telephone Number	:	813-805-8102
Fax Number	:	844-757-3729

Provider Business Practice Location Address
First Line	:	3010 E 138TH AVE STE 1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-3902
Country	:	US
Telephone Number	:	813-805-8102
Fax Number	:	844-757-3729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	03/02/2026

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