Provider Demographics
NPI:1083321269
Name:JOSEPH, FABIENIE (PTA)
Entity Type:Individual
Prefix:
First Name:FABIENIE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 WYMORE RD APT 104
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4225
Mailing Address - Country:US
Mailing Address - Phone:407-734-3786
Mailing Address - Fax:
Practice Address - Street 1:285 WYMORE RD APT 104
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4225
Practice Address - Country:US
Practice Address - Phone:407-734-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA32375208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation