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NPI Code Detail

MEDICARE: MR. EXPEDITO BALDEO KALLOS JR. PT

MEDICARE: MR. EXPEDITO BALDEO KALLOS JR. PT
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
1225100000XPhysical TherapistJ1-0002212DE

General Provider Information

NPI Number : 1699955997
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EXPEDITO BALDEO KALLOS JR. PT
Provider Business Mailing Address
First Line : 6151 PIEDMONT DR
Second Line :
City : SPRING HILL
State : FL
Zip : 34606-3823
Country : US
Telephone Number : 352-238-4039
Fax Number :
Provider Business Practice Location Address
First Line : 6151 PIEDMONT DR
Second Line :
City : SPRING HILL
State : FL
Zip : 34606-3823
Country : US
Telephone Number : 352-238-4039
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2007
Last Update Date : 11/05/2007

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