Provider Demographics
NPI:1336288497
Name:PRIETO, FLORENCIO A (PT)
Entity Type:Individual
Prefix:
First Name:FLORENCIO
Middle Name:A
Last Name:PRIETO
Suffix:
Gender:M
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:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-0597
Mailing Address - Country:US
Mailing Address - Phone:352-341-4600
Mailing Address - Fax:352-560-4224
Practice Address - Street 1:832 US HIGHWAY 41 S
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-6859
Practice Address - Country:US
Practice Address - Phone:352-341-4600
Practice Address - Fax:352-560-4224
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0248ZMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #