MEDICARE: EDGAR LADIA

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	225100000X	Physical Therapist	PT8143	FL

General Provider Information

NPI Number	:	1053844159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGAR LADIA

Provider Business Mailing Address
First Line	:	11430 GEORGETOWN CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10500 UNIVERSITY CENTER DR STE 130
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6415
Country	:	US
Telephone Number	:	813-977-7999
Fax Number	:

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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Directions to “ EDGAR LADIA ” Practice Location

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