Provider Demographics
NPI:1154685923
Name:FLORESTA, ROWENA (PT)
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:
Last Name:FLORESTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 LAKEVIEW DR
Mailing Address - Street 2:APARTMENT NUMBER 60
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-7917
Mailing Address - Country:US
Mailing Address - Phone:863-414-2663
Mailing Address - Fax:
Practice Address - Street 1:1851 ELKCAM BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3922
Practice Address - Country:US
Practice Address - Phone:386-789-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist