Provider Demographics
NPI:1518163021
Name:SCUDIERO, THOMAS GERARD (PTA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GERARD
Last Name:SCUDIERO
Suffix:
Gender:M
Credentials:PTA
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Mailing Address - Street 1:2123 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-735-8762
Mailing Address - Fax:813-874-2039
Practice Address - Street 1:2123 MARTIN LUTHER KING BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-878-9743
Practice Address - Fax:813-874-2039
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPTA9722225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant