Healthcare Provider Details

I. General information

NPI: 1659008092
Provider Name (Legal Business Name): NIALA RAMOUTAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 N CENTRAL AVE
KISSIMMEE FL
34741-4407
US

IV. Provider business mailing address

1207 N CENTRAL AVE
KISSIMMEE FL
34741-4407
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT39082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: