Healthcare Provider Details

I. General information

NPI: 1366644353
Provider Name (Legal Business Name): CAROLINA ROTONDO P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY NW 500
BOCA RATON FL
33487-2773
US

IV. Provider business mailing address

277 CULFORD RD
TORONTO ONTARIO
M6L2V4
CA

V. Phone/Fax

Practice location:
  • Phone: 561-367-1175
  • Fax:
Mailing address:
  • Phone: 716-471-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23234
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0002161
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028672-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: