Healthcare Provider Details

I. General information

NPI: 1043588288
Provider Name (Legal Business Name): ADRIANA PRIETO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W BASS ST
KISSIMMEE FL
34741-5001
US

IV. Provider business mailing address

300 W BASS ST
KISSIMMEE FL
34741-5001
US

V. Phone/Fax

Practice location:
  • Phone: 407-870-5959
  • Fax: 407-933-6468
Mailing address:
  • Phone: 407-870-5959
  • Fax: 407-933-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: