MEDICARE: MS. TESSA MARIA FERREIRA PTA

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	225200000X	Physical Therapy Assistant	22703	FL

General Provider Information

NPI Number	:	1649525114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TESSA MARIA FERREIRA PTA

Provider Business Mailing Address
First Line	:	2774 WILLOW BAY TER
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-6729
Country	:	US
Telephone Number	:	904-982-8573
Fax Number	:

Provider Business Practice Location Address
First Line	:	3451 TECHNOLOGICAL AVE STE 15
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-8353
Country	:	US
Telephone Number	:	407-514-3657
Fax Number	:

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

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	07/19/2012

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