MEDICARE: TCT RIDE LLC

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
1	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1184396715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TCT RIDE LLC

Provider Business Mailing Address
First Line	:	7548 S US HIGHWAY 1
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-1450
Country	:	US
Telephone Number	:	772-480-4410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 SW BRISBANE ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-3510
Country	:	US
Telephone Number	:	772-480-4410
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CANDICE GASPARRO
Credential	:
Telephone Number	:	772-480-4410

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	10/01/2021

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Directions to “TCT RIDE LLC ” Practice Location

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