Provider Demographics
NPI:1740953066
Name:CALTAGIRONE, SAMUEL EDWARD (PTA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EDWARD
Last Name:CALTAGIRONE
Suffix:
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 1:11616 MIRACLE MILE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4544
Mailing Address - Country:US
Mailing Address - Phone:813-727-7228
Mailing Address - Fax:
Practice Address - Street 1:8451 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5450
Practice Address - Country:US
Practice Address - Phone:813-605-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24775225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant