MEDICARE: TALLEY DYAN THOMPSON CARPENTER DPT

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	208100000X	Physical Medicine & Rehabilitation Physician	PT33359	FL

General Provider Information

NPI Number	:	1437641297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALLEY DYAN THOMPSON CARPENTER DPT

Provider Business Mailing Address
First Line	:	3657 CORTEZ RD W STE 110
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34210-3171
Country	:	US
Telephone Number	:	941-474-2700
Fax Number	:	941-474-8081

Provider Business Practice Location Address
First Line	:	2828 S MCCALL RD STE 25
Second Line	:
City	:	ENGLEWOOD
State	:	FL
Zip	:	34224-9517
Country	:	US
Telephone Number	:	941-474-2700
Fax Number	:	941-447-4808

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

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	06/06/2018

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