Provider Demographics
NPI:1912105768
Name:BOLDUC, NORMAN P (MPT)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:P
Last Name:BOLDUC
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 S BENEVA RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2472
Mailing Address - Country:US
Mailing Address - Phone:941-955-1850
Mailing Address - Fax:941-955-1852
Practice Address - Street 1:943 S BENEVA RD STE 204
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2472
Practice Address - Country:US
Practice Address - Phone:941-955-1850
Practice Address - Fax:941-955-1852
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI053ZMedicare PIN