Provider Demographics
NPI:1619202991
Name:FORTUNATO, TALAYNA I (MSPT)
Entity Type:Individual
Prefix:
First Name:TALAYNA
Middle Name:I
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 NORTHBROOKE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8095
Mailing Address - Country:US
Mailing Address - Phone:239-653-9586
Mailing Address - Fax:239-653-9587
Practice Address - Street 1:2546 NORTHBROOKE PLAZA DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8095
Practice Address - Country:US
Practice Address - Phone:239-653-9586
Practice Address - Fax:239-653-9587
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCK748YMedicare PIN