MEDICARE: MISS REBECCA LEIGH NORDMAN 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	225100000X	Physical Therapist	PT23399	FL

General Provider Information

NPI Number	:	1891985883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS REBECCA LEIGH NORDMAN DPT

Provider Business Mailing Address
First Line	:	7211 83RD AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34201-2151
Country	:	US
Telephone Number	:	904-377-4856
Fax Number	:	941-343-9402

Provider Business Practice Location Address
First Line	:	7211 83RD AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34201-2151
Country	:	US
Telephone Number	:	904-377-4856
Fax Number	:	941-343-9402

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	06/29/2011

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