Provider Demographics
NPI:1407109143
Name:BAYCARE HEALTH SYSTEM
Entity Type:Organization
Organization Name:BAYCARE HEALTH SYSTEM
Other - Org Name:ST. ANTHONY'S HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED PHYSICAL THERAPIST ASSIST.
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:CUDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-825-1231
Mailing Address - Street 1:4802 51ST ST W
Mailing Address - Street 2:#1303
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-5101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 7TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1300
Practice Address - Country:US
Practice Address - Phone:727-825-1231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 287273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL225200000XOtherPTA LICENSE # 287