Provider Demographics
NPI:1649409590
Name:HOWARD, IVY S (PT)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:S
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 AMERICAN EAGLE BLVD
Mailing Address - Street 2:SUITE #130
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33570
Mailing Address - Country:US
Mailing Address - Phone:813-634-1668
Mailing Address - Fax:
Practice Address - Street 1:1010 AMERICAN EAGLE BLVD
Practice Address - Street 2:SUITE #130
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33570
Practice Address - Country:US
Practice Address - Phone:813-634-1668
Practice Address - Fax:813-634-9578
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22450225100000X
NCP10265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist