Individual
MR. FEDERICO NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA20728
Contact information
Practice address
1441 FORTUNE RD, #256, KISSIMMEE, FL 34743
(352) 787-3188
(877) 399-5578
Mailing address
1441 FORTUNE RD, #256, KISSIMMEE, FL 34743
(352) 787-3188
(877) 399-5578
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA20728
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106898
MEDICARE ID
FL
Enumeration date
05/11/2009
Last updated
06/08/2015
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