MEDICARE: MR. AUGUST SUGUI GARCIA PTA

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	PTA21151	FL

General Provider Information

NPI Number	:	1992088090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AUGUST SUGUI GARCIA PTA

Provider Business Mailing Address
First Line	:	2861 ORANGE HAVEN WAY
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-1946
Country	:	US
Telephone Number	:	407-873-5903
Fax Number	:

Provider Business Practice Location Address
First Line	:	2861 ORANGE HAVEN WAY
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-1946
Country	:	US
Telephone Number	:	407-873-5903
Fax Number	:

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

Provider Enumeration Date	:	09/25/2011
Last Update Date	:	09/25/2011

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