Healthcare Provider Details

I. General information

NPI: 1396962858
Provider Name (Legal Business Name): HUGO A. NIETO P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 STRAWBERRY OAKS DR
ORANGE CITY FL
32763-7444
US

IV. Provider business mailing address

550 N FIRWOOD DR
DELTONA FL
32725-2687
US

V. Phone/Fax

Practice location:
  • Phone: 386-775-8607
  • Fax: 386-775-8607
Mailing address:
  • Phone: 386-566-4115
  • Fax: 386-951-2641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA20641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: