Healthcare Provider Details

I. General information

NPI: 1467780817
Provider Name (Legal Business Name): DANIEL PAUL D'ANDREA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 COLUMBIA ST
ORLANDO FL
32806-1115
US

IV. Provider business mailing address

60 COLUMBIA ST
ORLANDO FL
32806-1115
US

V. Phone/Fax

Practice location:
  • Phone: 407-643-1360
  • Fax: 407-635-5571
Mailing address:
  • Phone: 407-643-1360
  • Fax: 407-635-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007422
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: