Individual
MR. KLARENZ BULLECER QUIJANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5423 COUNTY ROAD 125, WILDWOOD, FL 34785-7995
(352) 231-8959
Mailing address
5423 COUNTY ROAD 125, WILDWOOD, FL 34785-7995
(352) 231-8959
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA25519
FL
Other
Enumeration date
02/17/2015
Last updated
02/17/2015
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