Healthcare Provider Details

I. General information

NPI: 1649037896
Provider Name (Legal Business Name): FISIOACTIVE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6649 BRIDGMAN ST
ORLANDO FL
32827-7941
US

IV. Provider business mailing address

6649 BRIDGMAN ST
ORLANDO FL
32827-7941
US

V. Phone/Fax

Practice location:
  • Phone: 407-233-9182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAURA ARBOLEDA CALDERON
Title or Position: PHYSICAL THERAPISTS
Credential: DPT
Phone: 407-233-9182