MEDICARE: MR. VENER SENTONES RAFAEL 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	11077	FL

General Provider Information

NPI Number	:	1669630927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VENER SENTONES RAFAEL RPT

Provider Business Mailing Address
First Line	:	4533 SUMMER WALK CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-1438
Country	:	US
Telephone Number	:	904-886-7064
Fax Number	:

Provider Business Practice Location Address
First Line	:	4533 SUMMER WALK CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-1438
Country	:	US
Telephone Number	:	904-886-7064
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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