Individual
RANDY VEGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
22917 SW 109TH AVE, MIAMI, FL 33170-7526
(786) 380-6912
Mailing address
22917 SW 109TH AVE, MIAMI, FL 33170-7526
(786) 380-6912
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA26511
FL
225700000X
Massage Therapist
MA61608
FL
Other
Enumeration date
03/04/2011
Last updated
08/28/2016
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