Provider Demographics
NPI:1518663087
Name:VIOLETTA, PHILIP CHRISTIAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:CHRISTIAN
Last Name:VIOLETTA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 2ND AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-1718
Mailing Address - Country:US
Mailing Address - Phone:407-236-7155
Mailing Address - Fax:407-236-7441
Practice Address - Street 1:801 N ORANGE AVE STE 610
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-5202
Practice Address - Country:US
Practice Address - Phone:407-236-7155
Practice Address - Fax:407-236-7441
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT39903OtherLICENSE