MEDICARE: ROMMEL M VESAGAS 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	024153	NY

General Provider Information

NPI Number	:	1982838637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMMEL M VESAGAS RPT

Provider Business Mailing Address
First Line	:	20817 JAMAICA AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20817 JAMAICA AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1546
Country	:	US
Telephone Number	:	718-465-4500
Fax Number	:

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

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	05/11/2009

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