Provider Demographics
NPI:1386308526
Name:HARWOOD, DOUGLAS (PTA)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:HARWOOD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 12TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5904
Mailing Address - Country:US
Mailing Address - Phone:727-424-6000
Mailing Address - Fax:
Practice Address - Street 1:9797 BAY PINES BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-3775
Practice Address - Country:US
Practice Address - Phone:727-398-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25876225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant