Provider Demographics
NPI:1811026081
Name:LADIA, AMOR MIGUEL (PT)
Entity Type:Individual
Prefix:MR
First Name:AMOR
Middle Name:MIGUEL
Last Name:LADIA
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 1:141 AVENUE C SW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3273
Mailing Address - Country:US
Mailing Address - Phone:863-293-3700
Mailing Address - Fax:863-292-0417
Practice Address - Street 1:141 AVENUE C SW
Practice Address - Street 2:SUITE 150
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3273
Practice Address - Country:US
Practice Address - Phone:863-293-3700
Practice Address - Fax:863-292-0417
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL213840OtherAMERIGROUP
FL826886OtherAETNA HMO
FL102318OtherAVMED
FLY910GOtherBCBS GROUP NO.
FL5239004OtherAETNA PPO
FLY910JOtherBCBS INDIVIDUAL NO.
FLY4056OtherBCBS INDIVIDUAL NO.
FL213840OtherAMERIGROUP
FL826886OtherAETNA HMO
FLY4056OtherBCBS INDIVIDUAL NO.