MEDICARE: ELIEZER HUERTAS 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

General Provider Information

NPI Number	:	1093178683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIEZER HUERTAS PTA

Provider Business Mailing Address
First Line	:	7959 HAMPTON LAKE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3662
Country	:	US
Telephone Number	:	760-684-5518
Fax Number	:

Provider Business Practice Location Address
First Line	:	7959 HAMPTON LAKE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3662
Country	:	US
Telephone Number	:	760-684-5518
Fax Number	:

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

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

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