Provider Demographics
NPI:1285703066
Name:ROSSILLO, PATRICK J (PT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:ROSSILLO
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 1:811 S ORLANDO AVE STE H
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7102
Mailing Address - Country:US
Mailing Address - Phone:407-539-1792
Mailing Address - Fax:845-703-6297
Practice Address - Street 1:811 S ORLANDO AVE STE H
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7102
Practice Address - Country:US
Practice Address - Phone:407-539-1792
Practice Address - Fax:845-703-6297
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02019941Medicaid
NYA400015363Medicare PIN
NYQ25801Medicare UPIN