Provider Demographics
NPI:1629623350
Name:SERRANO, OMAR GAMALIER
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:GAMALIER
Last Name:SERRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SEBURN RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-8466
Mailing Address - Country:US
Mailing Address - Phone:479-923-4904
Mailing Address - Fax:
Practice Address - Street 1:1706 E SEMORAN BLVD STE 107
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5610
Practice Address - Country:US
Practice Address - Phone:407-880-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist