Healthcare Provider Details

I. General information

NPI: 1891752655
Provider Name (Legal Business Name): MARY A DEL VENTO R.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4263 VIXEN CT
OVIEDO FL
32765-7558
US

IV. Provider business mailing address

4263 VIXEN CT
OVIEDO FL
32765-7558
US

V. Phone/Fax

Practice location:
  • Phone: 407-366-4877
  • Fax: 407-366-4877
Mailing address:
  • Phone: 407-366-4877
  • Fax: 407-366-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: