MEDICARE: MS. CONSUELO TIRADO LPTA, RPC, CNA

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	PTA22432	FL

General Provider Information

NPI Number	:	1982015244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONSUELO TIRADO LPTA, RPC, CNA

Provider Business Mailing Address
First Line	:	3601 BAY HEIGHTS WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1548
Country	:	US
Telephone Number	:	813-767-7768
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 BAY HEIGHTS WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1548
Country	:	US
Telephone Number	:	813-767-7768
Fax Number	:

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

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	05/08/2014

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