MEDICARE: CHRISTOPHER PEDRO P.T.A.

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	225200000X	Physical Therapy Assistant	PTA24733	FL

General Provider Information

NPI Number	:	1255755351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER PEDRO P.T.A.

Provider Business Mailing Address
First Line	:	1836 FOX CT
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6190
Country	:	US
Telephone Number	:	772-475-9277
Fax Number	:

Provider Business Practice Location Address
First Line	:	8993 OKEECHOBEE BLVD STE 100
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-5144
Country	:	US
Telephone Number	:	561-478-3702
Fax Number	:

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

Provider Enumeration Date	:	02/10/2014
Last Update Date	:	02/10/2014

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