Healthcare Provider Details

I. General information

NPI: 1962784140
Provider Name (Legal Business Name): MISS RIZZA BEJASA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 CORPORATE BLVD
ORLANDO FL
32817-8344
US

IV. Provider business mailing address

11315 CORPORATE BLVD
ORLANDO FL
32817-8344
US

V. Phone/Fax

Practice location:
  • Phone: 800-774-7785
  • Fax:
Mailing address:
  • Phone: 800-774-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: