Basic Information
| Provider Information | |||||||||
| NPI: | 1265942072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALIBA | ||||||||
| FirstName: | RAQUEL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1532 SUGARWOOD CIRCLE | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073420583 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 SOUTH CHICKASAW TRAIL | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073803466 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2017 | ||||||||
| LastUpdateDate: | 10/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT9929 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.