Provider Demographics
NPI:1780069872
Name:DIAZ, ERIK RAFAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:RAFAEL
Last Name:DIAZ
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 1:7940 VIA DELLAGIO WAY
Mailing Address - Street 2:SUITE 142
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7940 VIA DELLAGIO WAY
Practice Address - Street 2:SUITE 142
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5400
Practice Address - Country:US
Practice Address - Phone:407-745-4633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 30552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist