Healthcare Provider Details

I. General information

NPI: 1528921988
Provider Name (Legal Business Name): BANICIO JUNIOR ADONIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 HOOKS ST
CLERMONT FL
34711-3551
US

IV. Provider business mailing address

15540 KENSINGTON TRL
CLERMONT FL
34711-8138
US

V. Phone/Fax

Practice location:
  • Phone: 352-717-7980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number33836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: