MEDICARE: MR. OSIAS REYES CADORNA JR. RPT

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	PT9699	FL

General Provider Information

NPI Number	:	1457384562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OSIAS REYES CADORNA JR. RPT

Provider Business Mailing Address
First Line	:	8466 LOCKWOOD RIDGE RD
Second Line	:	#300
City	:	SARASOTA
State	:	FL
Zip	:	34243-2951
Country	:	US
Telephone Number	:	941-359-2977
Fax Number	:	941-359-2966

Provider Business Practice Location Address
First Line	:	255 COURTYARD BLVD
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5794
Country	:	US
Telephone Number	:	813-633-2887
Fax Number	:	813-864-8671

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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