Healthcare Provider Details

I. General information

NPI: 1740953066
Provider Name (Legal Business Name): SAMUEL EDWARD CALTAGIRONE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8451 US HIGHWAY 301 S
RIVERVIEW FL
33578-5450
US

IV. Provider business mailing address

11616 MIRACLE MILE DR
RIVERVIEW FL
33578-4544
US

V. Phone/Fax

Practice location:
  • Phone: 813-605-2516
  • Fax:
Mailing address:
  • Phone: 813-727-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA24775
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: