Provider Demographics
NPI:1336187087
Name:MURDOCH, KEVIN BARKLEY (PT, MS, OCS, MTC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:BARKLEY
Last Name:MURDOCH
Suffix:
Gender:M
Credentials:PT, MS, OCS, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 SR 64 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212
Mailing Address - Country:US
Mailing Address - Phone:941-792-1404
Mailing Address - Fax:941-795-1717
Practice Address - Street 1:8000 SR 64 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:941-795-1717
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2103654OtherFIRST HEALTH INDIV PROV #
FLY7564OtherBCBS INDIV PROV NUM
FL6698057OtherGHI INDIV PROV NUM
FL885462900Medicaid
FL6698057OtherGHI INDIV PROV NUM
FL885462900Medicaid