Provider Demographics
NPI:1275671984
Name:PATZLAFF, RICHARD SCOTT (PTA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SCOTT
Last Name:PATZLAFF
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-2886
Mailing Address - Country:US
Mailing Address - Phone:772-589-5341
Mailing Address - Fax:
Practice Address - Street 1:1155 MALABAR RD NE
Practice Address - Street 2:SUITE 13
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3245
Practice Address - Country:US
Practice Address - Phone:321-409-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 18338225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant