Provider Demographics
NPI:1265673644
Name:AUDITOR, BERNARD AGTUCA (PT)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:AGTUCA
Last Name:AUDITOR
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 1:5705 QUINTON WAY
Mailing Address - Street 2:STONEYBROOK HILLS
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-8030
Mailing Address - Country:US
Mailing Address - Phone:954-798-1354
Mailing Address - Fax:
Practice Address - Street 1:2810 RULEME ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6527
Practice Address - Country:US
Practice Address - Phone:352-483-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019791225100000X
NY031079-1225100000X
FLPT25425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist