Provider Demographics
NPI:1053410134
Name:TEMRAZ, KHALED (PT)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:TEMRAZ
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 1:23299 DUCHESS AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-2551
Mailing Address - Country:US
Mailing Address - Phone:941-639-8273
Mailing Address - Fax:
Practice Address - Street 1:312 NESBIT ST
Practice Address - Street 2:SUITE 112
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3828
Practice Address - Country:US
Practice Address - Phone:941-639-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y091NZMedicare ID - Type Unspecified