Provider Demographics
NPI:1912124546
Name:BINGENHEIMER, ROBERT DONALD JR (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DONALD
Last Name:BINGENHEIMER
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 1:312 S OLD DIXIE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7491
Mailing Address - Country:US
Mailing Address - Phone:561-748-8700
Mailing Address - Fax:561-748-8702
Practice Address - Street 1:312 S OLD DIXIE HWY
Practice Address - Street 2:STE 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7491
Practice Address - Country:US
Practice Address - Phone:561-748-8700
Practice Address - Fax:561-748-8702
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13392225100000X
FL299993612251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13392OtherFL PT LICENSE NUMBER