Provider Demographics
NPI:1396962858
Name:NIETO, HUGO A (PTA)
Entity type:Individual
Prefix:MR
First Name:HUGO
Middle Name:A
Last Name:NIETO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N FIRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2687
Mailing Address - Country:US
Mailing Address - Phone:386-566-4115
Mailing Address - Fax:386-951-2641
Practice Address - Street 1:202 STRAWBERRY OAKS DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7444
Practice Address - Country:US
Practice Address - Phone:386-775-8607
Practice Address - Fax:386-775-8607
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20641225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant