Provider Demographics
NPI:1396886818
Name:ARZONICO, THEODORE HENRY (MED, ATC, LAT)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:HENRY
Last Name:ARZONICO
Suffix:
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3843 BRANTLEY PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6855
Mailing Address - Country:US
Mailing Address - Phone:407-297-1318
Mailing Address - Fax:
Practice Address - Street 1:1200 OAKLEY SEAVER DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-241-0347
Practice Address - Fax:352-243-3610
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL16742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer