MEDICARE: DR. PABLO VEGA PT, DPT, CSCS

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	2251X0800X	Orthopedic Physical Therapist	PT34164	FL

General Provider Information

NPI Number	:	1952872475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PABLO VEGA PT, DPT, CSCS

Provider Business Mailing Address
First Line	:	5401 SW 41ST ST
Second Line	:
City	:	PEMBROKE PARK
State	:	FL
Zip	:	33023-6840
Country	:	US
Telephone Number	:	786-282-4586
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 HOLLYWOOD BLVD STE 200
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6926
Country	:	US
Telephone Number	:	954-986-2299
Fax Number	:

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

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	12/10/2018

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