Provider Demographics
NPI:1730840562
Name:TAVAREZ, JOHN ESTEBAN (PTA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ESTEBAN
Last Name:TAVAREZ
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 1:1901 W SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2017
Mailing Address - Country:US
Mailing Address - Phone:321-615-5135
Mailing Address - Fax:
Practice Address - Street 1:1465 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4854
Practice Address - Country:US
Practice Address - Phone:813-655-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA31709225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant