Provider Demographics
NPI:1902916240
Name:OSBORNE, DAVID RAINE JR (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RAINE
Last Name:OSBORNE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13618 GREENFIELD DR
Mailing Address - Street 2:#302
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8410
Mailing Address - Country:US
Mailing Address - Phone:727-403-4862
Mailing Address - Fax:
Practice Address - Street 1:2250 DREW ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3305
Practice Address - Country:US
Practice Address - Phone:727-791-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist