MEDICARE: DIOSADADO G SALAVERIA

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	PT19623	FL

General Provider Information

NPI Number	:	1316241797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIOSADADO G SALAVERIA

Provider Business Mailing Address
First Line	:	2427 PELICAN BAY COURT
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2427 PELICAN BAY CT
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32408-7053
Country	:	US
Telephone Number	:	800-521-9604
Fax Number	:

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

Provider Enumeration Date	:	12/29/2010
Last Update Date	:	12/29/2010

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Directions to “ DIOSADADO G SALAVERIA ” Practice Location

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