Basic Information
| Provider Information | |||||||||
| NPI: | 1962500082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBA-DIOSO | ||||||||
| FirstName: | RACHELLE | ||||||||
| MiddleName: | CASTROVERDE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4637 SUNTREE BLVD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328173358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077869357 | ||||||||
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| Practice Location | |||||||||
| Address1: | 134 N OLD DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | LADY LAKE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321594347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527516627 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | PT0013759 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.