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General NPI Number Information
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NPI Number | 1639366156
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Entity Type | Individual
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Provider Name | REGINALDO PARDILLA MORENO RPT
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Gender | Male
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 7236 STATE ROAD 52 SUITE 4
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City | BAYONET POINT
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State | FL
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Zip | 34667-6789
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Country | US
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Telephone | 727-946-0884
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Fax |
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Provider Business Mailing Address
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Address Line | 365 WOOD DOVE AVE
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-7530
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Country | US
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Telephone | 727-946-0884
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Fax |
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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 | PT#0005432
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License Number State | FL
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