Healthcare Provider Details

I. General information

NPI: 1881891141
Provider Name (Legal Business Name): CARMENSKA JOISIL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 SAN MARCO BLVD 15204 WEST COLONIAL DR. WINTER GARDEN, FL 32461
JACKSONVILLE FL
32207-8536
US

IV. Provider business mailing address

17132 ARBOR WOODS CT
ORLANDO FL
32820-2252
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-4133
  • Fax: 904-398-4148
Mailing address:
  • Phone: 321-274-2094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTA 20300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: