Provider Demographics
NPI:1821214420
Name:TRUJILLO, CARMEN CECILIA (PT,)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:CECILIA
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:PT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5263 GOLDEN GATE PKWY
Mailing Address - Street 2:UNIT E
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7601
Mailing Address - Country:US
Mailing Address - Phone:239-352-9884
Mailing Address - Fax:239-352-8610
Practice Address - Street 1:5263 GOLDEN GATE PKWY
Practice Address - Street 2:UNIT E
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7601
Practice Address - Country:US
Practice Address - Phone:239-352-9884
Practice Address - Fax:239-352-8610
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist