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NPI Code Detail

MEDICARE: TAMARA L BREDAR PTA

MEDICARE: TAMARA L BREDAR PTA
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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1407094782
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA L BREDAR PTA
Provider Business Mailing Address
First Line : 1896 PARK MEADOWS DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-3738
Country : US
Telephone Number : 239-939-5421
Fax Number :
Provider Business Practice Location Address
First Line : 1896 PARK MEADOWS DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-3738
Country : US
Telephone Number : 239-939-5421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2009
Last Update Date : 01/26/2009

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Directions to “ TAMARA L BREDAR PTA” Practice Location

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