Provider Demographics
NPI:1699200386
Name:PAGARA, RICHARD ARAT JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ARAT
Last Name:PAGARA
Suffix:JR
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 1:901 NE 18TH CT
Mailing Address - Street 2:APT 107
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-3834
Mailing Address - Country:US
Mailing Address - Phone:954-253-1686
Mailing Address - Fax:
Practice Address - Street 1:901 NE 18TH CT
Practice Address - Street 2:APT 107
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-3834
Practice Address - Country:US
Practice Address - Phone:954-253-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009840225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant