Provider Demographics
NPI:1609111483
Name:AGOSTINELLI, PHILIP (PT, DPT, OCS, ATC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:AGOSTINELLI
Suffix:
Gender:M
Credentials:PT, DPT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4909
Mailing Address - Country:US
Mailing Address - Phone:407-691-7687
Mailing Address - Fax:407-691-7697
Practice Address - Street 1:1341 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4909
Practice Address - Country:US
Practice Address - Phone:407-691-7687
Practice Address - Fax:407-691-7697
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27433225100000X
FLAL25612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist