Healthcare Provider Details

I. General information

NPI: 1073379327
Provider Name (Legal Business Name): RENATO PAUL BARTRA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 S POWERLINE RD
POMPANO BEACH FL
33069-4300
US

IV. Provider business mailing address

1830 N LAUDERDALE AVE APT 4218
NORTH LAUDERDALE FL
33068-4222
US

V. Phone/Fax

Practice location:
  • Phone: 954-975-0771
  • Fax:
Mailing address:
  • Phone: 954-547-9271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number29655
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: