Provider Demographics
NPI:1669630927
Name:RAFAEL, VENER SENTONES (RPT)
Entity Type:Individual
Prefix:MR
First Name:VENER
Middle Name:SENTONES
Last Name:RAFAEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:VINNIE
Other - Middle Name:S
Other - Last Name:RAFAEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4533 SUMMER WALK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1438
Mailing Address - Country:US
Mailing Address - Phone:904-886-7064
Mailing Address - Fax:
Practice Address - Street 1:4533 SUMMER WALK CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-1438
Practice Address - Country:US
Practice Address - Phone:904-886-7064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist