MEDICARE: VINICIUS LUIZ GUIMARAES SEBASTIAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT44107	FL

General Provider Information

NPI Number	:	1548123623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINICIUS LUIZ GUIMARAES SEBASTIAO

Provider Business Mailing Address
First Line	:	681 ADDISON LONGWOOD TER APT 219
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2576 S VOLUSIA AVE FL 32763
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-9120
Country	:	US
Telephone Number	:	386-774-4840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	03/31/2026

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