Provider Demographics
NPI:1790210581
Name:REPIEDAD, AGUINALDO LUMAIN III (PTA)
Entity Type:Individual
Prefix:MR
First Name:AGUINALDO
Middle Name:LUMAIN
Last Name:REPIEDAD
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SW 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4466
Mailing Address - Country:US
Mailing Address - Phone:352-237-7776
Mailing Address - Fax:
Practice Address - Street 1:4100 SW 33RD AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4466
Practice Address - Country:US
Practice Address - Phone:352-237-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA15178225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant