Provider Demographics
NPI:1497802755
Name:HOWARD PHYSICAL THERAPY CLINIC PA
Entity Type:Organization
Organization Name:HOWARD PHYSICAL THERAPY CLINIC PA
Other - Org Name:WOODRIDGE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:352-622-1881
Mailing Address - Street 1:2340 NE 2ND ST STE 500
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-8220
Mailing Address - Country:US
Mailing Address - Phone:352-622-1881
Mailing Address - Fax:352-622-1944
Practice Address - Street 1:2340 NE 2ND ST STE 500
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8220
Practice Address - Country:US
Practice Address - Phone:352-622-1881
Practice Address - Fax:352-622-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL881097400Medicaid
FL650025233OtherRAILROAD MEDICARE ID NBR
FL881097400Medicaid