Provider Demographics
NPI:1295802346
Name:PEPPER, PATRICIA L (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:PEPPER
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:PO BOX 50681
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0305
Mailing Address - Country:US
Mailing Address - Phone:941-228-6734
Mailing Address - Fax:
Practice Address - Street 1:13638 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-2725
Practice Address - Country:US
Practice Address - Phone:941-228-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY002MOtherBCBS OF FLORIDA
FLY002MOtherBCBS OF FLORIDA