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NPI Code Detail

MEDICARE: KETZIEL ESTRADA DPT

MEDICARE: KETZIEL ESTRADA DPT
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
1225100000XPhysical TherapistPT33977FL

General Provider Information

NPI Number : 1619535259
Entity Type Code : Individual
Provider Name (Legal Business Name) : KETZIEL ESTRADA DPT
Provider Business Mailing Address
First Line : 1226 E CUMBERLAND AVE UNIT 120
Second Line :
City : TAMPA
State : FL
Zip : 33602-4212
Country : US
Telephone Number : 787-608-3490
Fax Number :
Provider Business Practice Location Address
First Line : 2202 W OAK AVE
Second Line :
City : PLANT CITY
State : FL
Zip : 33563-7222
Country : US
Telephone Number : 813-754-3761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2019
Last Update Date : 05/30/2019

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Directions to “ KETZIEL ESTRADA DPT” Practice Location

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