Healthcare Provider Details

I. General information

NPI: 1124047790
Provider Name (Legal Business Name): ANTHONY JOSEPH MAULORICO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7509 STATE ROAD 52 SUMMIT MEDICAL CENTER - SUITE 130
BAYONET POINT FL
34667-6787
US

IV. Provider business mailing address

10902 MAY APPLE CT
LAND O LAKES FL
34638-7901
US

V. Phone/Fax

Practice location:
  • Phone: 727-862-5939
  • Fax: 727-862-7127
Mailing address:
  • Phone: 813-996-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 18181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: