Provider Demographics
NPI:1033322862
Name:CALIXTO, RENATO (PT)
Entity Type:Individual
Prefix:
First Name:RENATO
Middle Name:
Last Name:CALIXTO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14819 HUNTCLIFF PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5679
Mailing Address - Country:US
Mailing Address - Phone:407-826-5760
Mailing Address - Fax:
Practice Address - Street 1:1012 EMMETT ST
Practice Address - Street 2:SUITE C
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5415
Practice Address - Country:US
Practice Address - Phone:407-933-0891
Practice Address - Fax:407-933-0177
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0010137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist