MEDICARE: ELEANE Y TAMAYO SUAREZ 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	PTA27682	FL

General Provider Information

NPI Number	:	1699495374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANE Y TAMAYO SUAREZ PTA

Provider Business Mailing Address
First Line	:	1840 W 49TH ST STE 517
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2950
Country	:	US
Telephone Number	:	786-663-7276
Fax Number	:	305-397-2988

Provider Business Practice Location Address
First Line	:	1840 W 49TH ST STE 517
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2950
Country	:	US
Telephone Number	:	786-663-7276
Fax Number	:	305-397-2988

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

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	09/01/2022

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