MEDICARE: MR. ROBERT ALLEN DOLATA M.P.T.

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	PT017716	PA
2	225100000X	Physical Therapist	PT27730	FL

General Provider Information

NPI Number	:	1265483945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT ALLEN DOLATA M.P.T.

Provider Business Mailing Address
First Line	:	744 THE RIALTO
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34285-3524
Country	:	US
Telephone Number	:	941-484-5500
Fax Number	:	941-484-5510

Provider Business Practice Location Address
First Line	:	744 THE RIALTO
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34285-3524
Country	:	US
Telephone Number	:	941-484-5500
Fax Number	:	941-484-5510

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/18/2021

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