MEDICARE: MR. JASON PELAYO ALVIOR 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	PT22483	FL

General Provider Information

NPI Number	:	1437129848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON PELAYO ALVIOR PT

Provider Business Mailing Address
First Line	:	4609 BUCKEYE RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1635
Country	:	US
Telephone Number	:	813-962-6839
Fax Number	:	813-962-6839

Provider Business Practice Location Address
First Line	:	4609 BUCKEYE RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1635
Country	:	US
Telephone Number	:	813-962-6839
Fax Number	:	813-962-6839

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	12/24/2008

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