Provider Demographics
NPI:1073773750
Name:VAZQUEZ, CARMEN R (PT)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:R
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 COPPERFIELD TER
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5829
Mailing Address - Country:US
Mailing Address - Phone:407-695-3398
Mailing Address - Fax:
Practice Address - Street 1:881 COPPERFIELD TER
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5829
Practice Address - Country:US
Practice Address - Phone:407-695-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003587225100000X
FL0001991225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist