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NPI Code Detail

MEDICARE: MR. RODRIGO RICCI OCAMPOS RPT

MEDICARE: MR. RODRIGO RICCI OCAMPOS RPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT 10173FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT 10173OTHERFLLICENSE NUMBER
2Y8050OTHERFLBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1083837991
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RODRIGO RICCI OCAMPOS RPT
Provider Business Mailing Address
First Line : 2039 E EDGEWOOD DR STE 110
Second Line :
City : LAKELAND
State : FL
Zip : 33803-3601
Country : US
Telephone Number : 863-665-1185
Fax Number : 863-665-1761
Provider Business Practice Location Address
First Line : 2039 E EDGEWOOD DR STE 110
Second Line :
City : LAKELAND
State : FL
Zip : 33803-3601
Country : US
Telephone Number : 863-665-1185
Fax Number : 863-665-1761
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 07/08/2007

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