MEDICARE: RICARDO VAZ LPTA

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	27805	FL

General Provider Information

NPI Number	:	1174049977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO VAZ LPTA

Provider Business Mailing Address
First Line	:	4505 DORIS DR
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-4103
Country	:	US
Telephone Number	:	386-597-3992
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E 3RD AVE UNIT 6
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-3104
Country	:	US
Telephone Number	:	386-597-3992
Fax Number	:

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

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	08/24/2021

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