Provider Demographics
NPI:1144878265
Name:AMISTOSO, JOEL CANLAPAN (PT,DPT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:CANLAPAN
Last Name:AMISTOSO
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2866 GRAZELAND DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8215
Mailing Address - Country:US
Mailing Address - Phone:941-587-2800
Mailing Address - Fax:
Practice Address - Street 1:2866 GRAZELAND DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8215
Practice Address - Country:US
Practice Address - Phone:941-587-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist