MEDICARE: ADA RICARDO CANO 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	208100000X	Physical Medicine & Rehabilitation Physician	PTA26353	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTA26353	OTHER	FL	PTA

General Provider Information

NPI Number	:	1205335189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADA RICARDO CANO PTA

Provider Business Mailing Address
First Line	:	13730 HARRISON ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-6211
Country	:	US
Telephone Number	:	786-203-5804
Fax Number	:

Provider Business Practice Location Address
First Line	:	15524 NW 77TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5804
Country	:	US
Telephone Number	:	305-231-5266
Fax Number	:

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

Provider Enumeration Date	:	02/07/2018
Last Update Date	:	06/16/2018

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