Provider Demographics
NPI:1124583661
Name:BAUTISTA, ALMA CORAZON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:CORAZON
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S ORANGE AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2946
Mailing Address - Country:US
Mailing Address - Phone:407-236-0404
Mailing Address - Fax:407-643-2805
Practice Address - Street 1:7300 SANDLAKE COMMONS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8005
Practice Address - Country:US
Practice Address - Phone:407-345-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT343872251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic