Provider Demographics
NPI:1164144721
Name:AMBROSANO GIARRETA, FERNANDA BACCHI (PT)
Entity Type:Individual
Prefix:
First Name:FERNANDA
Middle Name:BACCHI
Last Name:AMBROSANO GIARRETA
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 1:14919 GUAVA BAY DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4157
Mailing Address - Country:US
Mailing Address - Phone:407-808-6466
Mailing Address - Fax:
Practice Address - Street 1:2520 N ORANGE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4638
Practice Address - Country:US
Practice Address - Phone:407-303-8280
Practice Address - Fax:407-808-8279
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist