Provider Demographics
NPI:1710562566
Name:URETA, WILFRED (PT)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:
Last Name:URETA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 ONE CENTER BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-2243
Mailing Address - Country:US
Mailing Address - Phone:407-718-3238
Mailing Address - Fax:
Practice Address - Street 1:539 ONE CENTER BLVD APT 206
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-2243
Practice Address - Country:US
Practice Address - Phone:407-718-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24002208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24002OtherPT FLORIDA DEPT OF HEALTH