Provider Demographics
NPI:1275781635
Name:DOCUMENTO, FAITH SAPIO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:FAITH
Middle Name:SAPIO
Last Name:DOCUMENTO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SE GOLDTREE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7563
Mailing Address - Country:US
Mailing Address - Phone:772-380-0025
Mailing Address - Fax:
Practice Address - Street 1:1405 SE GOLDTREE DR
Practice Address - Street 2:SUITE D
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7563
Practice Address - Country:US
Practice Address - Phone:772-380-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist