Organization
PATH MEDICAL, LLC
Active
Parent organization
PATH MEDICAL
Other names
Path Medical - South Tampa
Organization subpart
Yes
Provider details
NPI number
Legal business name
PATH MEDICAL
Authorized official
DR. NEIL BONNARDEL MD (DIRECTOR OF MEDICAL SERVICES)
(754) 218-2164
Entity
Organization
Contact information
Practice address
1369 PROVIDENCE RD, BRANDON, FL 33511-4885
(813) 982-3456
(813) 982-3457
Mailing address
2304 W OAKLAND PARK BLVD, OAKLAND PARK, FL 33311-1422
(754) 218-2164
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
HCC8643
FL
Other
Enumeration date
03/09/2017
Last updated
09/09/2019
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