Provider Demographics
NPI:1700986429
Name:ROTEA, FERMIN ROLAND (PT)
Entity type:Individual
Prefix:
First Name:FERMIN
Middle Name:ROLAND
Last Name:ROTEA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16019 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2861
Mailing Address - Country:US
Mailing Address - Phone:813-310-1526
Mailing Address - Fax:813-920-2787
Practice Address - Street 1:16019 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2861
Practice Address - Country:US
Practice Address - Phone:813-310-1526
Practice Address - Fax:813-920-2787
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0274AMedicare ID - Type Unspecified