Provider Demographics
NPI:1801864731
Name:MCBRIDE, PETER ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ROBERT
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 RIVERWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:KINGS MILLS
Mailing Address - State:OH
Mailing Address - Zip Code:45034-9774
Mailing Address - Country:US
Mailing Address - Phone:513-754-1183
Mailing Address - Fax:
Practice Address - Street 1:3187 WESTERN ROW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8045
Practice Address - Country:US
Practice Address - Phone:513-459-8599
Practice Address - Fax:513-459-8746
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT8304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT8404OtherSTATE LICENSE