Provider Demographics
NPI:1578972436
Name:ISHMAEL, ANDRE S (PT)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:S
Last Name:ISHMAEL
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 1:13036 WATERFORD WOOD CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6053
Mailing Address - Country:US
Mailing Address - Phone:407-292-2156
Mailing Address - Fax:407-241-2868
Practice Address - Street 1:1555 BOREN DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2989
Practice Address - Country:US
Practice Address - Phone:407-292-2156
Practice Address - Fax:407-241-2868
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT295442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 29544OtherLICENSURE FOR PHYSICAL THERAPY IN FLORIDA