Healthcare Provider Details

I. General information

NPI: 1982624771
Provider Name (Legal Business Name): PEDIATRIC POTENTIALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 WAYMONT CT
LAKE MARY FL
32746-6744
US

IV. Provider business mailing address

295 WAYMONT CT
LAKE MARY FL
32746-6744
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-3962
  • Fax: 407-323-1614
Mailing address:
  • Phone: 407-322-3962
  • Fax: 407-323-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN ARNONE
Title or Position: PRESIDENT
Credential:
Phone: 407-322-3962