Healthcare Provider Details

I. General information

NPI: 1649839226
Provider Name (Legal Business Name): OMAR SANCHEZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100210 OVERSEAS HWY
KEY LARGO FL
33037
US

IV. Provider business mailing address

219 SW 15TH PL
HOMESTEAD FL
33030-6661
US

V. Phone/Fax

Practice location:
  • Phone: 305-453-1088
  • Fax: 305-453-1183
Mailing address:
  • Phone: 305-510-7158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA28284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: