Healthcare Provider Details

I. General information

NPI: 1528257714
Provider Name (Legal Business Name): JULIO ALBERTO MAXIMILIANO DIAZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15373 CORTONA WAY
NAPLES FL
34120-0675
US

IV. Provider business mailing address

15373 CORTONA WAY
NAPLES FL
34120-0675
US

V. Phone/Fax

Practice location:
  • Phone: 239-850-8625
  • Fax:
Mailing address:
  • Phone: 239-850-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23138
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number23138
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: