Provider Demographics
NPI:1578962403
Name:VASQUEZ, ROBERTO (PTA)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:VASQUEZ
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 1:15523 SW 96TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3803
Mailing Address - Country:US
Mailing Address - Phone:786-271-0416
Mailing Address - Fax:
Practice Address - Street 1:7154 SW 47TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4664
Practice Address - Country:US
Practice Address - Phone:305-447-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist