Provider Demographics
NPI:1912517574
Name:ESCALANTE, MARIA LUISA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:ESCALANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6229 FAIRMONT LN
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-2269
Mailing Address - Country:US
Mailing Address - Phone:941-527-5901
Mailing Address - Fax:
Practice Address - Street 1:6229 FAIRMONT LN
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-2269
Practice Address - Country:US
Practice Address - Phone:941-527-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23221225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant