Provider Demographics
NPI:1538520093
Name:PAIVA, CHARLES DONALD (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DONALD
Last Name:PAIVA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-3510
Mailing Address - Country:US
Mailing Address - Phone:386-822-5649
Mailing Address - Fax:386-822-7809
Practice Address - Street 1:141 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-3510
Practice Address - Country:US
Practice Address - Phone:386-822-5649
Practice Address - Fax:386-822-7809
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22668225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant