MEDICARE: JULIE LORRAINE CABALLERO 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	PTA0371	FL
2	225200000X	Physical Therapy Assistant	2072885	TX
3	225200000X	Physical Therapy Assistant	8838	CA

General Provider Information

NPI Number	:	1346599800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE LORRAINE CABALLERO PTA

Provider Business Mailing Address
First Line	:	2301 S OCEAN DR
Second Line	:	APT 1708
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-2632
Country	:	US
Telephone Number	:	954-600-7661
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 S OCEAN DR
Second Line	:	APT 1708
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-2632
Country	:	US
Telephone Number	:	954-600-7661
Fax Number	:

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

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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