Individual
MS. PATTY C LICATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1565 SAXON BLVD, SUITE 301, DELTONA, FL 32725-5876
(386) 851-0901
(386) 851-2426
Mailing address
701 PLATINUM PT, FL 4, LAKE MARY, FL 32746-4871
(407) 206-4500
(407) 643-2802
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT13460
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y094Q
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/07/2006
Last updated
11/02/2021
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