Provider Demographics
NPI:1518519792
Name:VERGARA, DANIEL PEDRO
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PEDRO
Last Name:VERGARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162743
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-2743
Mailing Address - Country:US
Mailing Address - Phone:954-580-4080
Mailing Address - Fax:954-530-5096
Practice Address - Street 1:4800 NE 20TH TER STE 303
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-771-8177
Practice Address - Fax:954-771-3629
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01161993OtherDOB