Provider Demographics
NPI:1720108749
Name:FISCARO, VERONICA PENA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:PENA
Last Name:FISCARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 103RD AVE N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5478
Mailing Address - Country:US
Mailing Address - Phone:727-481-1694
Mailing Address - Fax:727-535-5856
Practice Address - Street 1:2007 DODGE ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-1814
Practice Address - Country:US
Practice Address - Phone:727-481-1694
Practice Address - Fax:727-535-5856
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4767AMedicare ID - Type UnspecifiedPHYSICAL THERAPIST