Healthcare Provider Details

I. General information

NPI: 1831756048
Provider Name (Legal Business Name): MAYRA RAMIREZ THOMAS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 N MILLS AVE
ARCADIA FL
34266-8811
US

IV. Provider business mailing address

3022 DARIUS AVE
NORTH PORT FL
34288-6526
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-5691
  • Fax: 863-494-8167
Mailing address:
  • Phone: 941-345-9768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA24350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: