Provider Demographics
NPI:1417115403
Name:VERGA, MICHELLE L (PTA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:VERGA
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 1:519 E BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8180
Mailing Address - Country:US
Mailing Address - Phone:813-684-4500
Mailing Address - Fax:813-684-0411
Practice Address - Street 1:519 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8180
Practice Address - Country:US
Practice Address - Phone:813-684-4500
Practice Address - Fax:813-684-0411
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA1099225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant