Provider Demographics
NPI:1922215391
Name:QUITOS, JOANNA (PTA, LMT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:QUITOS
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8280 MARA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-4938
Mailing Address - Country:US
Mailing Address - Phone:407-857-7990
Mailing Address - Fax:321-251-7877
Practice Address - Street 1:3206 S CONWAY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7348
Practice Address - Country:US
Practice Address - Phone:321-251-7877
Practice Address - Fax:321-206-8212
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18706225200000X
FLMA39476225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA18706OtherPHYSICAL THERAPIST ASSIST
FLMA39476OtherMASSAGE THERAPIST