Healthcare Provider Details

I. General information

NPI: 1295244713
Provider Name (Legal Business Name): HEATHER VAZ-ANTROBUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HIGHWAY 27 STE 5
MINNEOLA FL
34715-6265
US

IV. Provider business mailing address

600 N HIGHWAY 27 STE 5
MINNEOLA FL
34715-6265
US

V. Phone/Fax

Practice location:
  • Phone: 352-504-4533
  • Fax: 352-243-0272
Mailing address:
  • Phone: 352-504-4533
  • Fax: 352-243-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPY22653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: