Provider Demographics
NPI:1366789463
Name:BOLIN, IRENE (PT)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BOLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 ALLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9380
Mailing Address - Country:US
Mailing Address - Phone:407-777-7602
Mailing Address - Fax:
Practice Address - Street 1:1220 ALLENDALE DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9380
Practice Address - Country:US
Practice Address - Phone:407-777-7602
Practice Address - Fax:954-704-3396
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist