Provider Demographics
NPI:1992283733
Name:PAUTLER, BRIAN JOSEPH
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOSEPH
Last Name:PAUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 SHENANDOAH RUN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5463
Mailing Address - Country:US
Mailing Address - Phone:813-476-1483
Mailing Address - Fax:
Practice Address - Street 1:20577 AMBERFIELD DR BLDG 7
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-4323
Practice Address - Country:US
Practice Address - Phone:813-909-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist