Healthcare Provider Details

I. General information

NPI: 1578344875
Provider Name (Legal Business Name): DOUGLAS FIORENTINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 N SEMORAN BLVD
WINTER PARK FL
32792-2840
US

IV. Provider business mailing address

5733 OAK LAKE TRL
OVIEDO FL
32765-7366
US

V. Phone/Fax

Practice location:
  • Phone: 407-679-1515
  • Fax:
Mailing address:
  • Phone: 978-696-1698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34023
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: