Provider Demographics
NPI:1942286273
Name:BETANCOURT, OCIEL E (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:OCIEL
Middle Name:E
Last Name:BETANCOURT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 380967
Mailing Address - Street 2:
Mailing Address - City:MURDOCK
Mailing Address - State:FL
Mailing Address - Zip Code:33938-0967
Mailing Address - Country:US
Mailing Address - Phone:941-426-8100
Mailing Address - Fax:941-426-0800
Practice Address - Street 1:12767 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287
Practice Address - Country:US
Practice Address - Phone:941-426-8100
Practice Address - Fax:941-426-0800
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00244393OtherRAILROAD MEDICARE INDIVIDUAL PROVIDER NUMBER
FLY045UMedicare ID - Type UnspecifiedMEDICARE PTAN NUMBER