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General NPI Number Information
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NPI Number | 1154369544
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Entity Type | Individual
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Provider Name | FLORANTE JACINTO RPT
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Gender | Male
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 906 S MAIN ST SUITE 2
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City | PLYMOUTH
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State | MI
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Zip | 48170-2093
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Country | US
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Telephone | 734-455-4668
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Fax | 734-455-4668
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Provider Business Mailing Address
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Address Line | 13648 CANTERBURY DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-3310
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Country | US
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Telephone | 586-202-2383
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Fax | 586-795-3863
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501011643
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License Number State | MI
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