Provider Demographics
NPI:1124766274
Name:ZANTUA, ROBERTO CUSTODIA III (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:CUSTODIA
Last Name:ZANTUA
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LEGACY POINT AT UCF
Mailing Address - Street 2:2110 HESTIA LOOP
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:34765
Mailing Address - Country:US
Mailing Address - Phone:407-917-6418
Mailing Address - Fax:
Practice Address - Street 1:LEGACY POINTE AT UCF
Practice Address - Street 2:2110 HESTIA LOOP
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:407-917-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist