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General NPI Number Information
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NPI Number | 1508917758
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Entity Type | Individual
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Provider Name | NADINE ROSE DE FREITAS PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 220 N SYKES CREEK PKWY STE 200
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3490
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Country | US
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Telephone | 321-456-5214
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Fax | 321-521-1152
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Provider Business Mailing Address
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Address Line | 4209 GROVEWOOD LN
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City | TITUSVILLE
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State | FL
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Zip | 32780-5914
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Country | US
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Telephone | 321-385-1599
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Fax |
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT10558
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL383
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT10558
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License Number State | FL
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