Provider Demographics
NPI:1346378601
Name:VINUEZA-ESTRADA, YELITZA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:YELITZA
Middle Name:
Last Name:VINUEZA-ESTRADA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 PORTOBELLO CIR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-8500
Mailing Address - Country:US
Mailing Address - Phone:813-684-2898
Mailing Address - Fax:
Practice Address - Street 1:3248 LITHIA PINECREST RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-5682
Practice Address - Country:US
Practice Address - Phone:813-662-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA10262225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant