MEDICARE: CALITA FEAGINS 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	PTA25757	FL

General Provider Information

NPI Number	:	1164806980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALITA FEAGINS PTA

Provider Business Mailing Address
First Line	:	PO BOX 260142
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33685-0142
Country	:	US
Telephone Number	:	404-783-2155
Fax Number	:

Provider Business Practice Location Address
First Line	:	5108 EISENHOWER BLVD
Second Line	:	APT 4207
City	:	TAMPA
State	:	FL
Zip	:	33634-6313
Country	:	US
Telephone Number	:	404-783-2155
Fax Number	:

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

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	07/10/2015

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