Provider Demographics
NPI:1366644353
Name:ROTONDO, CAROLINA (PT)
Entity Type:Individual
Prefix:MS
First Name:CAROLINA
Middle Name:
Last Name:ROTONDO
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 1:277 CULFORD RD
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M6L2V4
Mailing Address - Country:CA
Mailing Address - Phone:716-471-7855
Mailing Address - Fax:
Practice Address - Street 1:5901 BROKEN SOUND PKWY NW
Practice Address - Street 2:500
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2773
Practice Address - Country:US
Practice Address - Phone:561-367-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23234225100000X
DEJ1-0002161225100000X
NY028672-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist