Healthcare Provider Details

I. General information

NPI: 1669744017
Provider Name (Legal Business Name): RONNIE PEDROSA BARGAYO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date: 12/22/2017
Reactivation Date: 04/25/2018

III. Provider practice location address

16244 S MILITARY TRL SUITE 750
DELRAY BEACH FL
33484-6534
US

IV. Provider business mailing address

16244 S MILITARY TRL SUITE 750
DELRAY BEACH FL
33484-6534
US

V. Phone/Fax

Practice location:
  • Phone: 407-701-5073
  • Fax: 561-450-6716
Mailing address:
  • Phone: 407-701-5073
  • Fax: 561-450-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032350
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: