Provider Demographics
NPI:1639838352
Name:CILIBERTI, JAMES CHRISTOPHER
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:CILIBERTI
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 1:1142 MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6498
Mailing Address - Country:US
Mailing Address - Phone:315-391-2095
Mailing Address - Fax:
Practice Address - Street 1:12184 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5012
Practice Address - Country:US
Practice Address - Phone:407-382-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31638225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant