Provider Demographics
NPI:1780624734
Name:LICATA, PATTY C (PT)
Entity type:Individual
Prefix:MS
First Name:PATTY
Middle Name:C
Last Name:LICATA
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:701 PLATINUM PT
Mailing Address - Street 2:FL 4
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4871
Mailing Address - Country:US
Mailing Address - Phone:407-206-4500
Mailing Address - Fax:407-643-2802
Practice Address - Street 1:1565 SAXON BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5876
Practice Address - Country:US
Practice Address - Phone:386-851-0901
Practice Address - Fax:386-851-2426
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPT134602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY094QOtherBLUE CROSS BLUE SHIELD