Provider Demographics
NPI:1184652034
Name:PIAZZA, CHARLES LAWRENCE JR (DPT, ATC, MTC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LAWRENCE
Last Name:PIAZZA
Suffix:JR
Gender:M
Credentials:DPT, ATC, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 LEXINGTON GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1013
Mailing Address - Country:US
Mailing Address - Phone:407-322-3442
Mailing Address - Fax:407-322-8404
Practice Address - Street 1:290 CLYDE MORRIS BLVD STE A1
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-316-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist