Provider Demographics
NPI:1780695189
Name:HAROLD, ROBERT JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:HAROLD
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:TERRA CEIA ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34250-0039
Mailing Address - Country:US
Mailing Address - Phone:941-758-2111
Mailing Address - Fax:941-758-2082
Practice Address - Street 1:5108 BEACON RD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-8764
Practice Address - Country:US
Practice Address - Phone:941-758-2111
Practice Address - Fax:941-758-2082
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7241YMedicare ID - Type Unspecified
FLY7241ZMedicare ID - Type Unspecified