Provider Demographics
NPI:1669744017
Name:BARGAYO, RONNIE PEDROSA (PT)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:PEDROSA
Last Name:BARGAYO
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 1:16244 S MILITARY TRL
Mailing Address - Street 2:SUITE 750
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6534
Mailing Address - Country:US
Mailing Address - Phone:407-701-5073
Mailing Address - Fax:561-450-6716
Practice Address - Street 1:16244 S MILITARY TRL
Practice Address - Street 2:SUITE 750
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6534
Practice Address - Country:US
Practice Address - Phone:407-701-5073
Practice Address - Fax:561-450-6716
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2018-04-25
Deactivation Date:2017-12-22
Deactivation Code:
Reactivation Date:2018-04-25
Provider Licenses
StateLicense IDTaxonomies
NY032350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3471014Medicaid
NYA400082314Medicare PIN