Provider Demographics
NPI:1699225904
Name:INGUANZO, FELIPE
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:
Last Name:INGUANZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KNUTH RD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4629
Mailing Address - Country:US
Mailing Address - Phone:561-330-8451
Mailing Address - Fax:
Practice Address - Street 1:1080 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1331
Practice Address - Country:US
Practice Address - Phone:561-330-8451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21126225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant