Provider Demographics
NPI:1699917542
Name:PENARANDA, CARLO T (PT)
Entity type:Individual
Prefix:MR
First Name:CARLO
Middle Name:T
Last Name:PENARANDA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12090 METRO PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-8365
Mailing Address - Country:US
Mailing Address - Phone:239-768-6396
Mailing Address - Fax:239-768-1676
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4365
Practice Address - Country:US
Practice Address - Phone:239-768-6396
Practice Address - Fax:239-763-1676
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT4617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBV432YMedicare PIN