Provider Demographics
NPI:1639499510
Name:FLORES, ANTONIO PANGILINAN JR (PT)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:PANGILINAN
Last Name:FLORES
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 LAKE CENTER DR APT 26205
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6534
Mailing Address - Country:US
Mailing Address - Phone:407-429-1228
Mailing Address - Fax:
Practice Address - Street 1:3530 LAKE CENTER DR APT 26205
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6534
Practice Address - Country:US
Practice Address - Phone:407-429-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist