MEDICARE: MRS. GASPARA BARDITCH MSPT, 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
1	225100000X	Physical Therapist	23916	FL

General Provider Information

NPI Number	:	1760653661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GASPARA BARDITCH MSPT, DPT

Provider Business Mailing Address
First Line	:	11223 SW 134TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-5337
Country	:	US
Telephone Number	:	786-399-8328
Fax Number	:

Provider Business Practice Location Address
First Line	:	11223 SW 134TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-5337
Country	:	US
Telephone Number	:	786-399-8328
Fax Number	:

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

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	01/15/2015

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