Provider Demographics
NPI:1376744003
Name:SZELAG, RICHARD A (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:SZELAG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 LAKEGLEN DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7711
Mailing Address - Country:US
Mailing Address - Phone:321-253-2712
Mailing Address - Fax:
Practice Address - Street 1:6050 BABCOCK ST SE
Practice Address - Street 2:SUITE 5
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-3996
Practice Address - Country:US
Practice Address - Phone:321-676-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 2291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist