MEDICARE: ELIEZER VINCENZO FLOREAN SR. 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	PTA24900	FL

General Provider Information

NPI Number	:	1992476139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIEZER VINCENZO FLOREAN SR. PTA

Provider Business Mailing Address
First Line	:	6804 SILVER BRANCH CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4925
Country	:	US
Telephone Number	:	813-928-4221
Fax Number	:

Provider Business Practice Location Address
First Line	:	6804 SILVER BRANCH CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4925
Country	:	US
Telephone Number	:	813-928-4221
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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