Provider Demographics
NPI:1952872475
Name:VEGA, PABLO (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:
Last Name:VEGA
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6840
Mailing Address - Country:US
Mailing Address - Phone:786-282-4586
Mailing Address - Fax:
Practice Address - Street 1:3325 HOLLYWOOD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6926
Practice Address - Country:US
Practice Address - Phone:954-986-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT341642251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic