Provider Demographics
NPI:1518559269
Name:MANZO, JOSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MANZO
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 1:10155 DOWDEN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5227
Mailing Address - Country:US
Mailing Address - Phone:407-569-1700
Mailing Address - Fax:407-569-1701
Practice Address - Street 1:10155 DOWDEN RD STE 302
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5227
Practice Address - Country:US
Practice Address - Phone:407-569-1700
Practice Address - Fax:407-569-1701
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36575225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist