Healthcare Provider Details

I. General information

NPI: 1265040042
Provider Name (Legal Business Name): JOVANNI TAVERAS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16968 W BELL RD # D401
SURPRISE AZ
85374-8943
US

IV. Provider business mailing address

21756 STATE ROAD 54 STE 102
LUTZ FL
33549-2905
US

V. Phone/Fax

Practice location:
  • Phone: 623-299-9190
  • Fax: 623-299-9191
Mailing address:
  • Phone: 727-475-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1331582
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: