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General NPI Number Information
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NPI Number | 1144857699
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Entity Type | Individual
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Provider Name | MARY C VEGA PT
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 2200 KINGS HWY UNIT 2F
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-5760
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Country | US
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Telephone | 941-888-4561
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Fax | 941-347-4695
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Provider Business Mailing Address
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Address Line | PO BOX 510326
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City | PUNTA GORDA
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State | FL
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Zip | 33951-0326
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Country | US
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Telephone | 941-888-4561
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Fax | 941-347-4695
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT5676
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License Number State | FL
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