Provider Demographics
NPI:1134141419
Name:IGNACIO, NANETTE M (RPT)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:M
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:NANETTE
Other - Middle Name:G
Other - Last Name:MEDENCELES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:5990 WHITE TAIL LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-4011
Mailing Address - Country:US
Mailing Address - Phone:863-651-6858
Mailing Address - Fax:407-886-2152
Practice Address - Street 1:1822 GRASMERE DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-7639
Practice Address - Country:US
Practice Address - Phone:407-435-4167
Practice Address - Fax:407-886-2152
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 19664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist