MEDICARE: ANDRE NINO OSIE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	35735	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35735	OTHER	FL	LICENSE NUMBER

General Provider Information

NPI Number	:	1194712679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE NINO OSIE PT

Provider Business Mailing Address
First Line	:	164 MANTE DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34743-7718
Country	:	US
Telephone Number	:	917-517-5363
Fax Number	:

Provider Business Practice Location Address
First Line	:	9685 LAKE NONA VILLAGE PL STE 205
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7322
Country	:	US
Telephone Number	:	407-972-0065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	08/28/2024

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