Provider Demographics
NPI:1386791713
Name:HOWARD, BRUCE B (RPT)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:B
Last Name:HOWARD
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 NE 2ND ST STE 500
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-8220
Mailing Address - Country:US
Mailing Address - Phone:352-622-1881
Mailing Address - Fax:352-622-1944
Practice Address - Street 1:2340 NE 2ND ST STE 500
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8220
Practice Address - Country:US
Practice Address - Phone:352-622-1881
Practice Address - Fax:352-622-1944
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2301OtherBC BS PROVIDER ID NBR
FL881097400Medicaid
FL650025233OtherRAILROAD MEDICARE ID NBR
FLY2301ZMedicare PIN