Provider Demographics
NPI:1386817542
Name:MAURO, RICHARD ANTHONY (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:MAURO
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 1:19104 CYPRESS GREEN DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9757
Mailing Address - Country:US
Mailing Address - Phone:813-597-8985
Mailing Address - Fax:813-436-8700
Practice Address - Street 1:19104 CYPRESS GREEN DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-9757
Practice Address - Country:US
Practice Address - Phone:813-597-8985
Practice Address - Fax:813-436-8700
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009292225100000X
NY019287225100000X
FLPT24674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I650362Medicare PIN