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General NPI Number Information
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NPI Number | 1851053144
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Entity Type | Individual
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Provider Name | DAREN KARL OLALDE TIBURCIO PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 3140 WATERMAN WAY
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City | TAVARES
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State | FL
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Zip | 32778-5252
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Country | US
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Telephone | 352-253-3892
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Fax | 352-258-3809
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Provider Business Mailing Address
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Address Line | 107 PERKINS ST APT 6
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City | LEESBURG
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State | FL
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Zip | 34748-4952
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Country | US
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Telephone | 352-895-7902
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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 | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | PT37815
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License Number State | FL
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