Healthcare Provider Details

I. General information

NPI: 1184877110
Provider Name (Legal Business Name): MR. WILLIAM CHARLES ABATE II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LEXINGTON GREEN LN
SANFORD FL
32771-1013
US

IV. Provider business mailing address

1245 RANCHERO AVE
TITUSVILLE FL
32780-5437
US

V. Phone/Fax

Practice location:
  • Phone: 407-688-0070
  • Fax: 407-688-0071
Mailing address:
  • Phone: 321-269-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 21425
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: