Provider Demographics
NPI:1033575238
Name:BAKRE, AMOL
Entity Type:Individual
Prefix:
First Name:AMOL
Middle Name:
Last Name:BAKRE
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 1:1100 S MAIN ST # 103
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-4910
Mailing Address - Country:US
Mailing Address - Phone:561-762-6866
Mailing Address - Fax:561-624-1192
Practice Address - Street 1:1100 S MAIN ST # 103
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4910
Practice Address - Country:US
Practice Address - Phone:561-762-6866
Practice Address - Fax:561-624-1192
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist