Provider Demographics
NPI:1417085069
Name:TEPASKE, PIETER H
Entity Type:Individual
Prefix:MR
First Name:PIETER
Middle Name:H
Last Name:TEPASKE
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 1:3657 CORTEZ RD W STE 110
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3171
Mailing Address - Country:US
Mailing Address - Phone:941-544-5060
Mailing Address - Fax:941-426-7044
Practice Address - Street 1:2530 BOBCAT VILLAGE CENTER RD UNIT C
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288
Practice Address - Country:US
Practice Address - Phone:941-426-7400
Practice Address - Fax:941-426-7044
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0007476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686515Medicare ID - Type Unspecified