MEDICARE: MS. JOHANNA QUIAMBAO DINGEL R.P.T.

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	PT23164	FL

General Provider Information

NPI Number	:	1982818589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOHANNA QUIAMBAO DINGEL R.P.T.

Provider Business Mailing Address
First Line	:	2954 CHIPPER DR NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-5705
Country	:	US
Telephone Number	:	501-773-6689
Fax Number	:

Provider Business Practice Location Address
First Line	:	4760 W. COMMERCIAL BLVD.
Second Line	:
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33319
Country	:	US
Telephone Number	:	866-608-2670
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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