Provider Demographics
NPI:1194712679
Name:OSIE, ANDRE NINO (PT)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:NINO
Last Name:OSIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 MANTE DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-7718
Mailing Address - Country:US
Mailing Address - Phone:917-517-5363
Mailing Address - Fax:
Practice Address - Street 1:9685 LAKE NONA VILLAGE PL STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7322
Practice Address - Country:US
Practice Address - Phone:407-972-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35735OtherLICENSE NUMBER