Provider Demographics
NPI:1154369544
Name:JACINTO, FLORANTE (RPT)
Entity type:Individual
Prefix:
First Name:FLORANTE
Middle Name:
Last Name:JACINTO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13648 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3310
Mailing Address - Country:US
Mailing Address - Phone:586-202-2383
Mailing Address - Fax:586-795-3863
Practice Address - Street 1:906 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2093
Practice Address - Country:US
Practice Address - Phone:734-455-4668
Practice Address - Fax:734-455-4668
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650H231180OtherBLUE CROSS BLUE SHIELD
MIP43480002Medicare PIN