Provider Demographics
NPI:1598105355
Name:AMUSO, NOLAN (DPT)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:
Last Name:AMUSO
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 1:3451 TECHNOLOGICAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-8353
Mailing Address - Country:US
Mailing Address - Phone:407-681-2520
Mailing Address - Fax:407-249-1414
Practice Address - Street 1:3451 TECHNOLOGICAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8353
Practice Address - Country:US
Practice Address - Phone:407-681-2520
Practice Address - Fax:407-249-1414
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist