Provider Demographics
NPI:1639333537
Name:PADILLA, ROBERT J (MA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1004
Mailing Address - Country:US
Mailing Address - Phone:813-932-0203
Mailing Address - Fax:813-932-6701
Practice Address - Street 1:1824 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1004
Practice Address - Country:US
Practice Address - Phone:813-932-0203
Practice Address - Fax:813-932-6701
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 53689225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist