Provider Demographics
NPI:1407094782
Name:BREDAR, TAMARA L (PTA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:BREDAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 PARK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3738
Mailing Address - Country:US
Mailing Address - Phone:239-939-5421
Mailing Address - Fax:
Practice Address - Street 1:1896 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3738
Practice Address - Country:US
Practice Address - Phone:239-939-5421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant