Brock Lister PT PA

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

31894 Issued in FL

Legal business name

BROCK LISTER PT PA

Practice address

2534 Wood Pointe Dr
Holiday, FL 34691-7803

Phone

(716) 523-1783

NPI assigned

May 7, 2017

Organization subpart

No

Name

Brock ListerNPI 1245612522

Title

Owner

Phone

(716) 523-1783

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brock Lister

  • Physical Therapist
  • Tampa, FL
  • NPI 1245612522
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 7, 2017.

{
    "created_epoch": "1494115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494115200000",
    "number": "1477089662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2534 WOOD POINTE DR",
            "city": "HOLIDAY",
            "state": "FL",
            "postal_code": "346917803",
            "telephone_number": "716-523-1783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2534 WOOD POINTE DR",
            "city": "HOLIDAY",
            "state": "FL",
            "postal_code": "346917803",
            "telephone_number": "716-523-1783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCK LISTER PT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-07",
        "last_updated": "2017-05-07",
        "status": "A",
        "authorized_official_last_name": "LISTER",
        "authorized_official_first_name": "BROCK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-523-1783"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "31894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betancourtaprnprimaryhealthcare.LLC
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• Robert Kent Bogle, MD
• Patricia Lynn Boswell, MA,CCC-SLP
• Kaila Boudewyn, B.A.
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• Caprise Burrowes, SPECIALIST
• Daliannis Barbara Cadrelo Nieto
• Scotty Bradford Canady, PHARMD, RPH
• Lynn Cantu, DC

• All providers in Holiday, FL
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.