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General NPI Number Information
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NPI Number | 1780271767
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Entity Type | Individual
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Provider Name | EMILIO ANTHONY AMADOR
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Gender | Male
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Dates
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Enumeration Date | 12/24/2020
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Last Update Date | 12/24/2020
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Provider Practice Location Address
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Address Line | 1601 6TH ST SE STE B
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4605
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Country | US
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Telephone | 863-294-0350
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Fax |
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Provider Business Mailing Address
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Address Line | 4030 DANIEL DR UNIT 113
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City | DAVENPORT
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State | FL
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Zip | 33837-3746
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Country | US
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Telephone | 786-942-8573
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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 | PT36619
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License Number State | FL
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