Provider Demographics
NPI:1831146018
Name:BARANDA, REY BELGA (PT)
Entity type:Individual
Prefix:
First Name:REY
Middle Name:BELGA
Last Name:BARANDA
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 1:6536 STADIUM DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7586
Mailing Address - Country:US
Mailing Address - Phone:813-715-7564
Mailing Address - Fax:813-782-4065
Practice Address - Street 1:6536 STADIUM DR
Practice Address - Street 2:SUITE E
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7586
Practice Address - Country:US
Practice Address - Phone:813-715-7564
Practice Address - Fax:813-782-4065
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891133900Medicaid
P00357769OtherMEDICARE RAILROAD
P00357769OtherMEDICARE RAILROAD