=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013218221
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FULVIO L SANCHEZ PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2010
-----------------------------------------------------
Last Update Date | 11/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 787 37TH ST STE E100
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-7304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-569-9747
-----------------------------------------------------
Fax | 772-569-9979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 KARRIGAN ST
-----------------------------------------------------
City | SEBASTIAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32958-6719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT14580
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------