MEDICARE: MRS. TAMARA PIMENTA PT

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	PT25679	FL

General Provider Information

NPI Number	:	1992019095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA PIMENTA PT

Provider Business Mailing Address
First Line	:	4047 13TH ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6772
Country	:	US
Telephone Number	:	407-957-0370
Fax Number	:	407-957-2975

Provider Business Practice Location Address
First Line	:	4047 13TH ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6772
Country	:	US
Telephone Number	:	407-957-0370
Fax Number	:	407-957-2975

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

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	07/30/2010

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