MEDICARE: MR. PEDRO E COLON PTA

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	21893	FL

General Provider Information

NPI Number	:	1407184625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PEDRO E COLON PTA

Provider Business Mailing Address
First Line	:	3161 S OCEAN DR APT 1408
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-7281
Country	:	US
Telephone Number	:	787-637-2575
Fax Number	:

Provider Business Practice Location Address
First Line	:	3161 S OCEAN DR APT 1408
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-7281
Country	:	US
Telephone Number	:	787-637-2575
Fax Number	:

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

Provider Enumeration Date	:	11/29/2009
Last Update Date	:	11/29/2009

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