Healthcare Provider Details

I. General information

NPI: 1639095375
Provider Name (Legal Business Name): DIEGO GABRIEL DORTA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 PASADENA AVE S
SOUTH PASADENA FL
33707-2032
US

IV. Provider business mailing address

724 PASADENA AVE S
SOUTH PASADENA FL
33707-2032
US

V. Phone/Fax

Practice location:
  • Phone: 727-289-1233
  • Fax:
Mailing address:
  • Phone: 727-289-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.70089782
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: