MEDICARE: CARLOS A SUAREZ PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	28676	FL

General Provider Information

NPI Number	:	1013512037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS A SUAREZ PTA

Provider Business Mailing Address
First Line	:	8321 SW 124TH AVE APT 105
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4610
Country	:	US
Telephone Number	:	786-395-8692
Fax Number	:

Provider Business Practice Location Address
First Line	:	8321 SW 124TH AVE APT 105
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4610
Country	:	US
Telephone Number	:	786-395-8692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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Directions to “ CARLOS A SUAREZ PTA” Practice Location

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