Provider Demographics
NPI:1891961777
Name:AGUIRRE, JOSE ANSELMO (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANSELMO
Last Name:AGUIRRE
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 1:2718 LEE BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1537
Mailing Address - Country:US
Mailing Address - Phone:239-303-1501
Mailing Address - Fax:239-303-9297
Practice Address - Street 1:2718 LEE BLVD
Practice Address - Street 2:STE C
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1537
Practice Address - Country:US
Practice Address - Phone:239-303-1501
Practice Address - Fax:239-303-9297
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22575174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist