Provider Demographics
NPI:1407143548
Name:BATTISTA, VIRGINIA M (ITDS)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:M
Last Name:BATTISTA
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 AMROTH PL
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5950
Mailing Address - Country:US
Mailing Address - Phone:407-739-1187
Mailing Address - Fax:
Practice Address - Street 1:2913 AMROTH PL
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5950
Practice Address - Country:US
Practice Address - Phone:407-739-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB323-873-54-871-0222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist