Basic Information
| Provider Information | |||||||||
| NPI: | 1396886818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARZONICO | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | HENRY | ||||||||
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| Credential: | MED, ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3843 BRANTLEY PLACE CIR | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327036855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072971318 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1200 OAKLEY SEAVER DRIVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522410347 | ||||||||
| FaxNumber: | 3522433610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AL1674 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.