MEDICARE: YAMARIE DIAZ LPTA

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	PTA14687	FL

General Provider Information

NPI Number	:	1932322328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMARIE DIAZ LPTA

Provider Business Mailing Address
First Line	:	6335 CONTESSA DR
Second Line	:	UNIT 301
City	:	ORLANDO
State	:	FL
Zip	:	32829-8004
Country	:	US
Telephone Number	:	407-208-9982
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 ALAFAYA WOODS BLVD
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-7095
Country	:	US
Telephone Number	:	407-365-7272
Fax Number	:	407-365-7272

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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