Healthcare Provider Details

I. General information

NPI: 1639838352
Provider Name (Legal Business Name): MR. JAMES CHRISTOPHER CILIBERTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12184 LAKE UNDERHILL RD
ORLANDO FL
32825-5012
US

IV. Provider business mailing address

1142 MARTIN BLVD
ORLANDO FL
32825-6498
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-3777
  • Fax:
Mailing address:
  • Phone: 315-391-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number31638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: