Provider Demographics
NPI:1700461191
Name:GARCON, DAFINIE (DPT, MSMS, MBA)
Entity Type:Individual
Prefix:DR
First Name:DAFINIE
Middle Name:
Last Name:GARCON
Suffix:
Gender:F
Credentials:DPT, MSMS, MBA
Other - Prefix:
Other - First Name:DAFINIE
Other - Middle Name:
Other - Last Name:JACQUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2865 AUTUMN BREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9273
Mailing Address - Country:US
Mailing Address - Phone:407-655-7206
Mailing Address - Fax:
Practice Address - Street 1:4705 S APOPKA VINELAND RD STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-3151
Practice Address - Country:US
Practice Address - Phone:407-905-9300
Practice Address - Fax:407-905-9309
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT36987225100000X
FLPT36987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist