Provider Demographics
NPI:1558585877
Name:TORDECILLAS, OLIVER GABAGAT (PT)
Entity Type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:GABAGAT
Last Name:TORDECILLAS
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 1:25351 TETHER LN
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5917
Mailing Address - Country:US
Mailing Address - Phone:941-204-8150
Mailing Address - Fax:
Practice Address - Street 1:25351 TETHER LN
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-5917
Practice Address - Country:US
Practice Address - Phone:941-204-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist