MEDICARE: RAFAEL PARDEIRO MSPT

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	225100000X	Physical Therapist	1148408	TX

General Provider Information

NPI Number	:	1205864212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL PARDEIRO MSPT

Provider Business Mailing Address
First Line	:	9501 ANCHUSA TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-2335
Country	:	US
Telephone Number	:	512-461-1902
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 ANCHUSA TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-2335
Country	:	US
Telephone Number	:	512-626-2025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	04/01/2020

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