Healthcare Provider Details

I. General information

NPI: 1932063476
Provider Name (Legal Business Name): DAVID MATILLA ORO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 MADACA LN
TAMPA FL
33618-2057
US

IV. Provider business mailing address

5901 E FOWLER AVE STE 100
TEMPLE TERRACE FL
33617-2305
US

V. Phone/Fax

Practice location:
  • Phone: 813-987-9700
  • Fax:
Mailing address:
  • Phone: 813-987-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA34497
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: