Healthcare Provider Details

I. General information

NPI: 1972002798
Provider Name (Legal Business Name): GIOVANNA ALEXANDRA CERVERA CUADROS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 S SEMORAN BLVD STE 39
ORLANDO FL
32822-1782
US

IV. Provider business mailing address

9787 OLD PATINA WAY
ORLANDO FL
32832-5823
US

V. Phone/Fax

Practice location:
  • Phone: 407-281-0228
  • Fax:
Mailing address:
  • Phone: 407-779-5217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT33090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: