Provider Demographics
NPI:1861521593
Name:ALBAY, PAUL EDGARDO CARDINEZ (PT)
Entity type:Individual
Prefix:
First Name:PAUL EDGARDO
Middle Name:CARDINEZ
Last Name:ALBAY
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 1:141 AVENUE C SW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3273
Mailing Address - Country:US
Mailing Address - Phone:863-293-3700
Mailing Address - Fax:863-292-0417
Practice Address - Street 1:141 AVENUE C SW
Practice Address - Street 2:SUITE 150
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3273
Practice Address - Country:US
Practice Address - Phone:863-293-3700
Practice Address - Fax:863-292-0417
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY910JOtherBCBS GROUP NO.
FLU2638YMedicare ID - Type UnspecifiedINDIVIDUAL NO.
FLY910JOtherBCBS GROUP NO.