Active NPI
Susana Rebecca P Vardeleon, , PT
- Physical Therapist
- Palm Harbor, FL
National Provider Identifier
1639525512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT31372
- Practice address
- 3515 Palm Harbor Blvd Ste a
Palm Harbor, FL 34683-1413 - Phone
- (727) 682-0056
- NPI assigned
- May 10, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT31372 | FL | Primary |
Addresses
Primary practice location
3515 Palm Harbor Blvd Ste a
Palm Harbor, FL 34683-1413
Mailing address
9811 Osceola Dr
New Port Richey, FL 34654-3434
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT31372 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524096000000",
"number": "1639525512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9811 OSCEOLA DR",
"city": "NEW PORT RICHEY",
"state": "FL",
"postal_code": "346543434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3515 PALM HARBOR BLVD STE A",
"city": "PALM HARBOR",
"state": "FL",
"postal_code": "346831413",
"telephone_number": "727-682-0056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VARDELEON",
"first_name": "SUSANA REBECCA",
"middle_name": "P",
"name_prefix": "Ms.",
"credential": ", PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-10",
"last_updated": "2018-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT31372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Harbor, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.