Provider Demographics
NPI:1972014256
Name:OSORIO, MARIO (ATC)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:OSORIO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 SW 49TH TER APT 3634
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-5680
Mailing Address - Country:US
Mailing Address - Phone:786-510-0293
Mailing Address - Fax:
Practice Address - Street 1:1845 SW 49TH TER APT 3634
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5680
Practice Address - Country:US
Practice Address - Phone:786-510-0293
Practice Address - Fax:786-510-0293
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer