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General NPI Number Information
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NPI Number | 1538071774
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Entity Type | Individual
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Provider Name | ANDRE HENRIQUE PROSISE MOURA PT
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Gender | Male
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 5579 S ORANGE AVE
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City | EDGEWOOD
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State | FL
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Zip | 32809-3493
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Country | US
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Telephone | 407-241-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 16480 WINDSOR CAY BLVD APT 301
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City | CLERMONT
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State | FL
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Zip | 34714-7336
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Country | US
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Telephone | 689-323-9433
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT45358
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License Number State | FL
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