Healthcare Provider Details

I. General information

NPI: 1306469655
Provider Name (Legal Business Name): ROXANA K FACCHINELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

2021 SCRUB JAY RD
APOPKA FL
32703-1699
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4003
  • Fax:
Mailing address:
  • Phone: 939-579-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: