Provider Demographics
NPI:1851053144
Name:TIBURCIO, DAREN KARL OLALDE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DAREN KARL
Middle Name:OLALDE
Last Name:TIBURCIO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:107 PERKINS ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4952
Mailing Address - Country:US
Mailing Address - Phone:352-895-7902
Mailing Address - Fax:
Practice Address - Street 1:3140 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5252
Practice Address - Country:US
Practice Address - Phone:352-253-3892
Practice Address - Fax:352-258-3809
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT378152251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology