Provider Demographics
NPI:1982069910
Name:GARBALOSA, VICTOR OMAR (DPT)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:OMAR
Last Name:GARBALOSA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 POE ST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-6548
Mailing Address - Country:US
Mailing Address - Phone:954-554-3346
Mailing Address - Fax:
Practice Address - Street 1:1414 POE ST
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-6548
Practice Address - Country:US
Practice Address - Phone:954-554-3346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist