Provider Demographics
NPI:1407306988
Name:BOUGRAT FERMIN, EDRIANA ISABEL (DPT)
Entity Type:Individual
Prefix:
First Name:EDRIANA
Middle Name:ISABEL
Last Name:BOUGRAT FERMIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HILDA ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741
Mailing Address - Country:US
Mailing Address - Phone:407-933-6684
Mailing Address - Fax:
Practice Address - Street 1:201 HILDA ST
Practice Address - Street 2:SUITE 12
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-933-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist