Individual provider Active NPI

Dexter Noland McDonald, RPT

  • Physical Therapist
  • Bradenton, FL
National Provider Identifier
1346448453
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT4414 Issued in FL
Practice address
502 5TH Avenue Dr E
Bradenton, FL 34208-2006
Phone
(941) 747-5847
NPI assigned
Jul 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT4414 FL Primary

Addresses

Primary practice location

502 5TH Avenue Dr E
Bradenton, FL 34208-2006

Mailing address

502 5TH Avenue Dr E
Bradenton, FL 34208-2006
Phone (941) 747-5847

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110603000428 FL Practitioner - Physical Therapist in Private Practice 4486831203 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT4414FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bridge Rehabilitation Therapies, Inc. Physical Therapist CurrentSince Feb 15, 2011 Accepting new patients

Locations

502 5th Avenue Dr E
Bradenton, FL 34208
Phone (941) 747-5847

714 Manatee Ave E
Bradenton, FL 34208
Phone (941) 212-2010

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1346448453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 5TH AVENUE DR E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342082006",
            "telephone_number": "941-747-5847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 5TH AVENUE DR E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342082006",
            "telephone_number": "941-747-5847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "DEXTER",
        "middle_name": "NOLAND",
        "name_prefix": "Mr.",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT4414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.