Provider Demographics
NPI:1720105257
Name:VISSERS, PAUL (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:VISSERS
Suffix:
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 1:7601 DELLA DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7233
Mailing Address - Country:US
Mailing Address - Phone:407-903-9444
Mailing Address - Fax:407-903-9445
Practice Address - Street 1:7601 DELLA DR STE 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7233
Practice Address - Country:US
Practice Address - Phone:407-903-9444
Practice Address - Fax:407-903-9445
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1932122298Medicare ID - Type UnspecifiedVISSER PHYSICAL THERAPY