Provider Demographics
NPI:1790764140
Name:POZO, TEMISTOCLES RUBEN (PT)
Entity Type:Individual
Prefix:
First Name:TEMISTOCLES
Middle Name:RUBEN
Last Name:POZO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 BLUE BAY CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7219
Mailing Address - Country:US
Mailing Address - Phone:561-236-4523
Mailing Address - Fax:561-478-9349
Practice Address - Street 1:6508 BLUE BAY CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7219
Practice Address - Country:US
Practice Address - Phone:561-236-4523
Practice Address - Fax:561-478-9349
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8774XOtherMEDICARE PTAN SENIOR FIRST
FLY8774YOtherMEDICARE PTAN CENTER FOR BALANCE, DIZZINESS
FLY8774XOtherMEDICARE PTAN SENIOR FIRST
FLY8774YMedicare PIN