MEDICARE: NICHOLAS VULTAGGIO

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	PT36082	FL

General Provider Information

NPI Number	:	1346851839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS VULTAGGIO

Provider Business Mailing Address
First Line	:	21756 STATE ROAD 54 STE 102
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-2905
Country	:	US
Telephone Number	:	727-475-5540
Fax Number	:

Provider Business Practice Location Address
First Line	:	5535 CYPRESS GARDENS BLVD STE 260
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-2241
Country	:	US
Telephone Number	:	727-475-5540
Fax Number	:

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

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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Directions to “ NICHOLAS VULTAGGIO ” Practice Location

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