Healthcare Provider Details

I. General information

NPI: 1598307993
Provider Name (Legal Business Name): INTEGUMENTARY PHYSIOTHERAPY INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 E STATE ROAD 434 UNIT 1021
LONGWOOD FL
32750-5284
US

IV. Provider business mailing address

587 E STATE ROAD 434 UNIT 1021
LONGWOOD FL
32750-5284
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-3238
  • Fax: 321-972-3590
Mailing address:
  • Phone: 321-972-3238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. NILMA ZULEIKA ELIAS SANTIAGO
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 321-972-3238