MEDICARE: RAMIR BAUTISTA SORIANO PT

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	15502	FL

General Provider Information

NPI Number	:	1407212244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMIR BAUTISTA SORIANO PT

Provider Business Mailing Address
First Line	:	5634 HILLVIEW CT
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-3246
Country	:	US
Telephone Number	:	863-513-9058
Fax Number	:	863-583-0390

Provider Business Practice Location Address
First Line	:	5634 HILLVIEW CT
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-3246
Country	:	US
Telephone Number	:	863-513-9058
Fax Number	:	863-583-0390

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

Provider Enumeration Date	:	01/09/2016
Last Update Date	:	01/09/2016

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