Healthcare Provider Details

I. General information

NPI: 1972342640
Provider Name (Legal Business Name): VINCENT HUFANDA HUFANDA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W SR 434 STE 204
LONGWOOD FL
32750-5165
US

IV. Provider business mailing address

6141 LOKEY DR
ORLANDO FL
32810
US

V. Phone/Fax

Practice location:
  • Phone: 407-767-5842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: